title: Wound dehiscence after penetrating keratoplasty: clinical characteristics of 51 cases treated at Bascom Palmer Eye Institute.
abstract: OBJECTIVE
  To describe the causes, clinical characteristics, and treatment of wound dehiscence in patients after penetrating keratoplasty (PK).
  
  
  METHODS
  A retrospective chart review was completed, evaluating patients seen at Bascom Palmer Eye Institute between 1989 and 2001.
  
  
  RESULTS
  All dehiscence occurred at the graft-host junction with an average of 5 hours of dehiscence, but no site preference was identified. Dehiscence occurred because of trauma (53%), suture-related complications (27%), infectious keratitis (8%), and spontaneous wound separation (12%). Twelve patients had either intraocular lens dislocation or expulsion; 42 patients underwent primary repair; 7 patients underwent primary PK; and 1 patient underwent primary evisceration. Surgical details were unavailable for 1 patient. Final visual acuity ranged from 20/20 to no light perception. Acuity was unavailable for 2 patients. Visual acuity was 20/200 or better in 23 patients (47%) and less than 20/200 in 26 patients (53%). Two patients (4%) had no light perception. The visual acuity of 13 patients (27%) was 20/40 or better at their last clinic visit. Comparison of predehiscence and postdehiscence visual acuity showed that 23 eyes (54%) had comparable vision after dehiscence, 11 eyes (25%) had improved vision, and 9 eyes (21%) had worsening of vision.
  
  
  CONCLUSIONS
  These observations show that graft dehiscence can occur for a variety of reasons after PK, including trauma, infectious keratitis, suture failure, or spontaneous wound separation. The graft-host interface remains vulnerable after corneal transplant and is a potential area for wound dehiscence even many years after keratoplasty. Nevertheless, comparable or even improved vision is possible after wound dehiscence.
authors.affiliation: Michigan State University, Verdier Eye Center, Grand Rapids, MI 49546, USA. annrenucci@yahoo.com
authors.forename: Ann M
authors.initials: AM
authors.lastname: Renucci
authors.forename: Fabiana Bogossian
authors.initials: FB
authors.lastname: Marangon
authors.forename: William W
authors.initials: WW
authors.lastname: Culbertson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003316:Corneal Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013997:Time Factors