Wound dehiscence after penetrating keratoplasty.

BACKGROUND: The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes. METHODS: The medical records of patients who experienced blunt traumatic wound dehiscence after PK between 1995 and 2015 were analyzed retrospectively. The incidence and etiology of the trauma, the time interval between PK and globe rupture, final graft clarity, best-corrected visual acuity, complications, secondary surgeries, and factors potentially affecting wound dehiscence size were recorded. RESULTS: This study included a total of 39 patients with a mean age of 42.66±16.66 years, of whom 23 patients were male and 16 patients were female. The incidence of wound dehiscence was 2.3%. The mean interval between the PK procedure and wound dehiscence was 25.91±47.24 months and the mean follow-up time was 34.43±51.02 months. The most common trauma mechanism was force with a blunt object (53.8%) and the most frequent site of wound dehiscence was the temporal quadrant (30.8%), the wound ranging from 30° to 270° in size. The patients were divided into 4 groups according to wound dehiscence size. As the size of the wound dehiscence size increased, the male ratio increased, wound dehiscence was more commonly located in the nasal and superior quadrants, lens injury and posterior segment complications were more frequent, and graft transparency was achieved at a lower rate. CONCLUSION: Traumatic wound dehiscence after PK is rare, but may lead to serious, lifelong consequences, including eye loss. Patients should be well informed about the risks and potential sequelae of wound dehiscence.

Effect of Donor Cornea on the Surgical Outcomes of Penetrating Keratoplasty: Imported Cornea Versus Domestic Cornea.

OBJECTIVES: In this study, we compared the surgical outcomes of penetrating keratoplasty using domestic and imported donor corneas. MATERIALS AND METHODS: We retrospectively evaluated 200 eyes and 200 consecutive patients who underwent penetrating keratoplasty by using domestic and imported donor corneas between January 2013 and December 2013. The donor characteristics, preoperative clinical features, and clinical outcomes at 6, 12, 24, and 36 months were assessed. RESULTS: No significant differences existed between the 2 groups with respect to age, sex, lateralization, and penetrating keratoplasty indication (P > .05). Donor age was lower (P = .012), the death-to-preservation time and the preservation-to-surgery time were shorter, the rate of epithelial defect was lower, and the endothelial cell count was higher in the domestic group (P < .001). The 2 groups were also similar in terms of developing persistent epithelial defect, glaucoma, keratitis, and graft survival (P > .05). CONCLUSIONS: We observed no significant differences in clinical outcomes during and after penetrating keratoplasty surgery between imported and domestic donor corneas.

Combined recession and resection surgery in the management of convergence excess esotropia with different levels of AC/A ratio.

PURPOSE: To study prospectively the effect of extirpating the proprioceptive impulse at the myotendinous junction combined with recession of the medial rectus muscles in patients with convergence excess esotropia. METHODS: A total of 21 patients with different sizes of AC/A ratios (high, 8; normal, 12; low, 1) underwent a surgical procedure consisting of combining resection of 2.5 mm of the insertional end of the medial rectus muscles with recession from the original insertion, based on the patient's angle of esotropia at 1/3 m while wearing full cycloplegic refraction, with an additional recession of 1 mm for each rectus muscle based on current surgical tables. A satisfactory outcome was defined as orthotropia or esotropia of <10Δ at near and distance fixations with available correction and reduction of the distance--near disparity to <10Δ. RESULTS: All patients, regardless of the size of AC/A ratio and the amount of near-distance disparity, had satisfactory alignments at near and distance fixations, with residual near-distance disparity of <10Δ. Consecutive distance exotropia did not develop even when there was preoperative distance orthotropia. Outcome measures remained stable for a mean of 4.3 years. None of the 8 patients with high AC/A ratios required bifocal wear or overcorrection prescriptions to maintain alignment postoperatively. CONCLUSIONS: This technique of combined resection and recession of the medial rectus muscle shows promise in the treatment of convergence excess esotropia. The main advantage is improvement in distance alignment while selectively reducing the near angle in patients with different levels of AC/A ratios.