Traumatic wound dehiscence after penetrating keratoplasty: case series and literature review

Abstract

If a timely and adequate treatment of the traumatically dislocated transplant can be given, it is likely that the transplant will survive. Nevertheless, severely reduced visual acuity (i.e., < hand movement) and lens damage at the time of trauma are the most reliable predictors for the final visual outcome. A permanent loss of visual acuity is related rather to the intraocular damage (vitreous loss, vitreous bleeding, retinal tears, and retinal detachment) than to the readapted transplant itself.

Traumatic wound dehiscence after penetrating keratoplasty

“…[14,19,[28][29][30][31] It has been noted that the most frequent indications in TWD are keratoconus, corneal scars, bullous keratopathy, herpetic keratitis, and Fuchs endothelial dystrophy. [4,11,14,[16][17][18][19][20]22,23,[25][26][27][28][29][30][31][32] In the present study, the most frequent PK indications were consistent with the general literature: corneal scar, keratoconus, leukoma, and bullous keratopathy. As these are most common indications for PK, [33] there are no definite data concerning the relationship between TWD and PK indications.…”

“…[11,14,[16][17][18][19]22,25,26,31] In our series, when pretraumatic and final visual acuities were compared, visual acuity was improved in 5 eyes, unchanged in 7, and worse in 14 cases. In patients whose final visual acuity was worse, the trauma was severe enough to cause ≥120° graft dehiscence (with the exception of patients 13 and 22) and/or crystalline lens/IOL damage (patients 5, 9, 13, 15, 19 and 25); posterior segment complications were also noted (patients 9, 13, 19, 23) ( Table 2).…”

“…Other studies also support this finding, and damage to crystalline lens or IOL at presentation (commonly accompanied by posterior segment injury) has been proposed as a bad prognostic sign for final visual acuity in such eyes. [26,27] Likewise, three of our patients with posterior segment damage also had concomitant crystalline lens or IOL damage.…”

“…[11,16,20,23,24] However, many graft ruptures occur during daily activities that are considered 'low-risk activities'. [22] Previous reports have noted that traumatic graft dehiscence was most often due to sports-or accident-related injuries and intentional assaults in the younger age group, [25,26] whereas falls or self-inflicted poking were found to be more frequent in the older age group. [17,25,27] In the current study, fall-related injuries were significantly more frequent compared to other causes in the older age group.…”

“…Likewise, other studies have also reported this region to be the most frequent site of wound separation. [16][17][18][19][20][25][26][27][28][29][30][31][32] The presence of sutures does not seem to protect against wound dehiscence, and there are differing reports about the effect of suturing techniques. [11,18,19,20,25,27] In our study group, interrupted suture was the most commonly used suturing technique, and in 16 (61.7%) eyes, all or some of the sutures were in place at the time of injury.…”