Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

ABSTRACT

PURPOSE: To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP). METHODS: This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair. RESULTS: The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048). CONCLUSIONS: The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.