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

TY - JOUR

T1 - Traumatic wound dehiscence after penetrating keratoplasty: case series and literature review.

AU - Steinberg, Johannes

AU - Eddy, Mau-Thek

AU - Katz, Toam

AU - Fricke, Otto H

AU - Richard, Gisbert

AU - Linke, Stephan

PY - 2011

Y1 - 2011

N2 - Purpose. Blunt trauma after penetrating keratoplasty (PK) is a high risk for wound rupture at the donor-recipient interface. We present 6 cases of traumatic wound dehiscence after PK; we describe the morphologic and functional outcome after surgical intervention and provide a review of the current literature. Methods. Six patients with a traumatic wound dehiscence after PK were analyzed retrospectively from the files of the University Eye Hospital Hamburg-Eppendorf (1998-2009). In addition, a comprehensive literature review was performed. Results. The indications for PK were keratoconus, corneal scars, and Fuchs endothelial dystrophy. The age range was 22-81 years; the time span between PK and globe rupture was 1 month to 27 years. The cause of the dislocation was a fall or blunt trauma, through a branch, airbag, fist, or finger. The corrected distance visual acuity (CDVA) pretrauma ranged between hand movement and 20/32. The CDVA after wound repair was 20/400 to 20/25 depending on the severity of the trauma. In 3 of the 6 cases, visual rehabilitation was superior to the pretrauma vision, whereas in 3 cases the pretrauma CDVA could not be reached. Conclusions. 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.

AB - Purpose. Blunt trauma after penetrating keratoplasty (PK) is a high risk for wound rupture at the donor-recipient interface. We present 6 cases of traumatic wound dehiscence after PK; we describe the morphologic and functional outcome after surgical intervention and provide a review of the current literature. Methods. Six patients with a traumatic wound dehiscence after PK were analyzed retrospectively from the files of the University Eye Hospital Hamburg-Eppendorf (1998-2009). In addition, a comprehensive literature review was performed. Results. The indications for PK were keratoconus, corneal scars, and Fuchs endothelial dystrophy. The age range was 22-81 years; the time span between PK and globe rupture was 1 month to 27 years. The cause of the dislocation was a fall or blunt trauma, through a branch, airbag, fist, or finger. The corrected distance visual acuity (CDVA) pretrauma ranged between hand movement and 20/32. The CDVA after wound repair was 20/400 to 20/25 depending on the severity of the trauma. In 3 of the 6 cases, visual rehabilitation was superior to the pretrauma vision, whereas in 3 cases the pretrauma CDVA could not be reached. Conclusions. 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.

KW - Adult

KW - Aged, 80 and over

KW - Cornea

KW - Corneal Diseases

KW - Eye Injuries

KW - Female

KW - Humans

KW - Keratoplasty, Penetrating

KW - Lens Implantation, Intraocular

KW - Male

KW - Retrospective Studies

KW - Surgical Wound Dehiscence

KW - Time Factors

KW - Visual Acuity

KW - Wounds, Nonpenetrating

KW - Young Adult

U2 - 10.5301/ejo.5000057

DO - 10.5301/ejo.5000057

M3 - SCORING: Journal article

C2 - 22009915

VL - 22

SP - 335

EP - 341

JO - EUR J OPHTHALMOL

JF - EUR J OPHTHALMOL

SN - 1120-6721

IS - 3

M1 - 3

ER -