Traumatic wound dehiscence after penetrating keratoplasty: case series and literature review

Abstract

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. 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. 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. 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.