title: Penetrating keratoplasty and anterior segment reconstruction for severe ocular trauma.
abstract: The authors reviewed 39 consecutive cases of severe ocular trauma that had undergone penetrating keratoplasty plus anterior segment reconstruction and evaluated visual outcome, graft survival, and secondary complications. Postoperatively, 49% of eyes achieved visual acuity of 20/100 or better compared with 10% before surgery, and 72% improved at least 2 Snellen lines. With a mean follow-up of 23 months, 31 (80%) initial keratoplasties remained clear, and all 4 subsequently re-grafted corneas maintained clarity, for an overall keratoplasty success rate of 90%. Elevated intraocular pressure occurred postoperatively in 18 eyes (46%), and, among these, 10 of 13 eyes (77%) had preoperative glaucoma, whereas 8 of 26 (31%) did not (P less than or equal to 0.015). Preoperative anterior synechiae could be anatomically corrected at surgery in 80% of cases (24 of 30 eyes). In 7 cases with persistent synechiae, 6 (86%) were associated with glaucoma (P less than or equal to 0.025). Retinal detachment occurred in one case. Thus, despite major trauma and a high prevalence of glaucoma, both the visual restoration and anatomic reconstruction achieved were satisfactory and without severe complications.
authors.affiliation: Cornea Service, Massachusetts Eye and Ear Infirmary, Boston.
authors.forename: K R
authors.initials: KR
authors.lastname: Kenyon
authors.forename: T
authors.initials: T
authors.lastname: Starck
authors.forename: P S
authors.initials: PS
authors.lastname: Hersh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000293:injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D065306:Corneal Injuries; D015807:Eye Injuries, Penetrating / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012590:Sclera / Q000293:injuries; D014792:Visual Acuity