Clinical Ophthalmology (Nov 2019)

Comparative Evaluation Of Clinical Characteristics And Visual Outcomes Of Traumatic And Non-Traumatic Graft Dehiscence Following Corneal Transplantation Surgery

  • Stevenson LJ,
  • Abell RG,
  • McGuinness MB,
  • Vajpayee RB

Journal volume & issue
Vol. Volume 13
pp. 2243 – 2249

Abstract

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Louis J Stevenson,1 Robin G Abell,1 Myra B McGuinness,2 Rasik B Vajpayee1,3,4 1Royal Victorian Eye and Ear Hospital, Melbourne, Victoria 3002, Australia; 2Centre for Eye Research Australia, Melbourne, Victoria 3002, Australia; 3University of Melbourne, Parkville, Victoria 3010, Australia; 4Vision Eye Institute, Melbourne, Victoria 3004, AustraliaCorrespondence: Rasik B VajpayeeRoyal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, AustraliaEmail [email protected]: To compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.Methods: Retrospective review of all patients presenting with post-keratoplasty wound dehiscence to the Royal Victorian Eye and Ear Hospital between January 2005 and December 2017. Patients with wound dehiscence following keratoplasty of any cause were included.Results: Of 71 eyes from 71 patients included, 60 (85%) were penetrating keratoplasty patients. The mean age was 56.4 years (SD=22.7, range 17.6–97) and 62% (n = 44) of patients were male. There were 28 (39%) cases of traumatic dehiscence and 43 (61%) cases of non-traumatic dehiscence. The median time interval from keratoplasty to dehiscence was significantly less in non-traumatic patients than traumatic patients (0.2 years, IQR 0.1–2.0 vs 2.3 years, IQR 0.3–14.8, p=0.01). There was no significant difference in best-corrected visual acuity at 6 months between traumatic and non-traumatic dehiscence (6/60 vs 6/36, p=0.62), suture technique (continuous vs interrupted, p=0.12), or graft type (penetrating keratoplasty vs deep anterior lamellar keratoplasty) after adjusting for keratoconus (p=0.41).Conclusion: Post-keratoplasty wound dehiscence is a serious complication and can cause significant loss of vision. While the risk of dehiscence is lifelong, the first 3 years post-keratoplasty carry the highest risk, with non-traumatic dehiscence tending to occur earlier than traumatic dehiscence.Keywords: graft dehiscence, trauma, keratoplasty, cornea

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