Traumatic wound dehiscence after penetrating keratoplasty: Clinical features and outcome in 53 cases in Yemen

Abstract

AIMS: Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management and outcome of surgery for traumatic wound dehiscence occurring in patients who had PKP. SUBJECTS AND METHODS: This retrospective study included post-PKP patients who sustained traumatic wound dehiscence at the Cornea Unit in Yemen Magrabi Eye Hospital between 2008 and 2016. Fifty-three eyes with a history of wound dehiscence were treated with primary wound closure. Patient files were reviewed for type and time of injury, distance visual acuity (VA), and outcome. RESULTS: Ruptured globe with dehiscence of wound occurred on average 2.4 years (3 months to 13 years) after PKP. The mean age at wound dehiscence was 22.27 years and males accounted for 77.4% (41). All patients were managed with primary closure of the wound. Lensectomy of traumatic or dislocated lens was the most frequent additional surgical procedure (14, 26.4%), followed by anterior vitrectomy (6, 11.3%). In the end, 43 (81.1%) grafts remained clear. In the last follow-up, 34 eyes (64.1%) had best-corrected VA of 20/200 or better and two eyes had no perception of light. CONCLUSION: Rupture globe and wound dehiscence occurs after PKP at the graft–host junction. Wound dehiscence is a lifelong risk after PKP and wound weakness persisted for a long period after PKP. Visual outcome and graft survival are generally poor after the injury, and the restoration of a satisfactory visual result is possible if treated early.

Keywords

• graft survival
• ocular trauma
• penetrating keratoplasty
• traumatic wound dehiscence