[Clinical observation of wound dehiscence after penetrating keratoplasty].

OBJECTIVE: To investigate the treatment of wound dehiscence after penetrating keratoplasty and to evaluate the influence of this complication on visual outcome.

METHODS: A retrospective analysis of 32 patients with wound dehiscence that undergone penetrating keratoplasty in Zhongshan Ophthalmic Center from July 1997 to June 2003 was performed. All involved eyes were undergone wound repair with or without iris excision, lensectomy, intraocular lens removal, anterior vitrectomy and stage I or stage II pars plana vitrectomy with gas or silicone oil tamponade according to variable extents of host-graft wound dehiscence in individual patient. Visual outcome, transparency of graft, intraocular pressure and structure integrity of ocular posterior segment were followed-up for 6-18 months in details. These data were used to summarize the specific characteristics of this type of ocular trauma.

RESULTS: Surgical outcomes were recorded as the following: 24 eyeballs were rescued, but eight of them developed phthisis bulbi. Broken or loose sutures of eyes were found in eight cases. Six cases achieved better visual acuity, all of which maintained clear grafts with normal intraocular pressure, and no vitreous hemorrhage or choroidal/retinal detachment occurred. In 14 eyes with wound dehiscence of 1/4-1/2 circle, eight cases ended with decreased visual acuity, 11 with grafts opacities, five with abnormal intraocular pressure (above or below the normal range). In eight eyes with wound dehiscence of 1/2-3/4 circle, seven cases got decreased visual acuity, five with graft opacities, seven with abnormal intraocular pressure, four with vitreous hemorrhage, and four developing choroidal/retinal detachment. In the two eyes with wound dehiscence over 3/4 circle, both resulted in graft opacities with no light perception. Vitreous hemorrhage, choroidal/retinal detachment as well as phthisis bulbi occurred due to low intraocular pressure.

CONCLUSIONS: After penetrating keratoplasty, the wounds of corneal graft show tectonic instability and poor resistance to tension. Traumatic wound dehiscence after penetrating keratoplasty often complicate with intraocular content herniation, vitreous hemorrhage, and choroidal/retinal detachment. Usually, this kind of trauma is from severe injuries and prognosis is worse than the common ocular trauma.