[Traumatic wound dehiscence and lens extrusion after penetrating keratoplasty]

To investigate the risk factors of wound dehiscence and lens extrusion following blunt trauma in patients with penetrating keratoplasty [PK] as well as the results of treatment. In a retrospective case series, 7 eyes of 7 patients including 6 male and one female subjects were investigated. All cases received primary care at the time of referral and then underwent secondary repair under general anesthesia in operation room setting. After evaluation of the wound, anterior vitrectomy was performed and secondary wound repair was done using nylon 10-0. Mean age of patients was 20.6 +/- 6.2 [range 10 to 30] years and mean interval between keratoplasty and trauma was 15.6 +/- 10.1 [range 2.5 to 26.5] months. Mean best-corrected visual acuity of patients before the trauma and at final follow-up was 0.6 +/- 0.38 logMAR [20/80] and 0.9 +/- 0.96 logMAR [20/160], respectively. In one case, visual acuity decreased to light perception after the final treatment. No case needed regraft. Most prevalent site of dehiscence was superior to the graft [4 cases] and the most prevalent cause of blunt trauma was hitting by hand. No case of endophthalmitis occurred. PK patients are susceptible to wound dehiscence due to trauma especially during the first postoperative year. This is more prevalent in young male subjects who are more prone to trauma because of higher social activities. Proper explanation of this problem for patients together with using protective eye shields as well as performing lamellar keratoplasty instead of PK if possible can decrease side effects of trauma in these patients

[Candida interface keratitis after deep anterior lamellar keratoplasty: clinical, microbiologic, histopathologic and confocal microscopic reports]

To report the clinical, histopathologic, microbiologic and confocal microscopic features of Candida keratitis after deep anterior lamellar keratoplasty [DALK]. The first patient presented with asymptomatic white to cream-colored interface deposits two months after DALK. Confocal scan disclosed clusters of hyper-reflective fine granular deposits in the interface with no evidence of inflammation or hypha-like structures. With a presumptive clinical diagnosis of progressive epithelial down-growth, irrigation of the interface was performed. Finally, penetrating keratoplasty was performed due to rupture in the Descemet's membrane. Histopathologic examination of the cornea disclosed yeast-like structures at the interface area. Microbiologic results of the irrigation fluid demonstrated Candida glabrata. The second patient presented with symptomatic infiltration of the inferior interface close to the suture site 2.5 months after DALK. Confocal scan disclosed foci of inflammation with clusters of hyper-reflective roundshaped structures that resembled epithelial cells. With a clinical diagnosis of epithelial down growth and progression of the lesion, penetrating keratoplasty was performed. Histopathologic examination of the cornea revealed acute and chronic granulomatous keratitis due to yeast-like structures. The microbiologic results demonstrated infection with Candida albicans. Clinical and confocal features of interface Candida keratitis may resemble those of epithelial down-growth, which may postpone correct diagnosis and treatment. Candida keratitis should be considered in cases of interface deposits after any form of lamellar keratoplasty