Traumatic wound dehiscence after penetrating keratoplasty: case series and literature review.
OBJECTIVE
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.
Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Johannes
J
Steinberg
Mau-Thek
MT
Eddy
Toam
T
Katz
Otto H
OH
Fricke
Gisbert
G
Richard
Stephan J
SJ
Linke
D000328:Adult; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000601:surgery; D065306:Corneal Injuries; D005131:Eye Injuries / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D008297:Male; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014949:Wounds, Nonpenetrating / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult