Traumatic Dehiscence Research Articles

Lamellar scleral patch autograft after ballistic accident: A case report

Scleral graft has been used in clinical situations including perforating eye trauma to treat traumatic scleral dehiscence. A 28-year-old male patient presented for a painful left eye following a firearm-related injury few hours ago. Visual acuity was limited to light perception with a 2 mm wide, oval-shaped inferior scleral gap. Due to the size of the scleral defect, we decided to perform a scleral autograft. The graft was fashioned from the inferonasal sclera, deposited over the recipient hole, and secured with 10–0 nylon sutures on the corneal and scleral sides of the surgical bed with favorable anatomical and refractive outcomes.

Traumatic flap dehiscence 15 years after LASIK: case report and review of the literature

Introduction: Corneal flap trauma rarely occurs years after laser in situ keratomileusis (LASIK), and management is not standardized. The authors report a case of LASIK flap dehiscence 15 years postoperatively with a review of the literature describing clinical characteristics, management, and outcomes of similar cases occurring at least 6 years postoperatively. Patient and Clinical Findings: A 55-year-old man with a history of LASIK surgery 15 years prior presented with flap dehiscence after trauma with a tree branch. His right eye uncorrected distance visual acuity (UDVA) at presentation was counting fingers. On slitlamp examination, the medial flap edge was folded underneath the temporal aspect. Diagnosis, Intervention, and Outcomes: The flap was unfolded, irrigated, repositioned, and instilled with topical antibiotics. The patient was started on prednisolone acetate 1% and moxifloxacin. On postoperative day 1, his UDVA improved to 20/50 and the flap remained centered and clear. His vision stabilized at 20/30 after 7 months. Peripheral epithelial ingrowth was noted without visual axis obscuration. Conclusions: This case, along with 20 reported instances of late traumatic flap dehiscence, highlights that early recognition with prompt intervention can optimize visual outcomes. Comparison of injury mechanisms, treatments, and complications may guide surgeons in patient counseling and care.

Clinical Outcomes in Patients With Traumatic Dehiscence of Penetrating Keratoplasty Grafts.

The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts. Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating keratoplasty grafts. The study cohort consisted of 65 eyes of 65 patients. The mean age at presentation was 72 years (SD 18), with a male predominance (65%). The most common indications for PKP included keratoconus (42%), corneal scar (31%), and Fuchs corneal dystrophy (8%). Dehiscence occurred as a result of blunt trauma in 94% of cases, and the mean wound length was 6.4 clock hours (SD 2.4), with a predominance of inferior dehiscence. The mean presenting visual acuity (VA) was 2.45 logMAR (SD 0.41), and the mean final VA was 2.17 logMAR (SD 0.99). Graft failure occurred in 64% of patients, and 22% underwent repeat PKP. When stratified by indication for corneal transplantation (keratoconus vs. other), there was no significant difference in graft age at the time of rupture, final VA, rate of graft failure, or rate of repeat PKP. Traumatic dehiscence of corneal grafts remains a rare but serious subtype of ocular trauma with generally poor visual prognoses. Presenting VA along with severity of trauma and posterior segment involvement tend to be the worst prognostic factors in final visual outcome.

Extensor mechanism injury, infection, and an extended time between trauma and surgical approach are related to the need for total knee arthroplasty removal after traumatic dehiscence

BackgroundSurgical wound-related traumatic complications are rarely reported in the literature. Traumatic dehiscence is unpredictable because of the trauma magnitude and the potential of associated injuries. This study aims to report the clinical outcomes and complications of a case series due to traumatic dehiscence after total knee arthroplasty (TKA) and establish possible criteria for prognosis for maintaining the implant. MethodsPatients admitted to an emergency room due to traumatic dehiscence after TKA were retrospectively evaluated. Patient data was analyzed and patients who maintained or not the arthroplasty were compared to establish prognosis factors. ResultsThirty-two patients with traumatic dehiscence after TKA were evaluated. The trauma occurred on a mean of 14.3 +/- 25.0 days after the surgical procedure, and debridement in the operating room was performed on a mean of 6.2 +/- 4.9 hours after the trauma. Twenty patients maintained the arthroplasty until the end of follow-up and did not require revision. Factors related to arthroplasty removal were associated extensor mechanism injury (p = 0.026), time from trauma to surgical debridement (p = 0.035), and infection (p = 0.0001) ConclusionTraumatic dehiscence after total knee arthroplasty is an event with a high rate of complications. Extensor mechanism Injury, infection, and extended time between trauma and surgical intervention were poor prognostic factors for arthroplasty maintenance.

Complications in deep anterior lamellar keratoplasty - A retrospective cross sectional interventional analysis in a large series.

To analyse complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of anterior corneal stroma. This was a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2021. A total of 484 eyes in 378 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman's membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post-LASIK ectasia, descemetocele, postcollagen cross-linking aborted melt and dense scar, and postradial keratotomy were included in the study. The patients were followed up for 17.6±9.4 months(1-10years). Complications noted in the surgery were intraoperatively Descemet's membrane perforation in 32 eyes (6.6%), postoperatively secondary glaucoma in 16 eyes (3.31%), cataract in 7 eyes (1.45%), suture-related complications in 5 eyes (1.03%), graft rejection in 3 eyes (0.61%), traumatic dehiscence in 2 eyes (0.41%), filamentary keratitis in 2 eyes (0.41%), interface infiltrate in 1 eye (0.21%), and recurrence of disease in 4 eyes (8.77%) out of 57 eyes with corneal dystrophy. DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases has proven to be better time and again. It has become an automatic choice for diseases of anterior cornea requiring keratoplasty. Complications occurring at any stage of surgery can be identified and managed effectively resulting in optimal outcome. This article compiles complications post DALK.

Complications in deep anterior lamellar keratoplasty - A retrospective interventional analysis in a large series.

To analyze the complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of the anterior corneal stroma. This is a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2020. A total of 474 eyes in 373 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman's membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post-laser-assisted in situ keratomileusis ectasia, descematocele, post-collagen cross-linking aborted melt and dense scar, and post-radial keratotomy were included in the study. The patients were followed up for 17.2 +/- 9.2 months (1-9 years). Complications noted in the surgery were intra-operatively Descemet's membrane perforation in 31 eyes (6.54%), post-operatively secondary glaucoma in 16 eyes (3.37%), cataract in seven eyes (1.47%), suture-related complications in five eyes (1.05%), graft rejection in three eyes (0.63%), traumatic dehiscence in two eyes (0.42%), filamentary keratitis in two eyes (0.42%), interface infiltrate in one eye (0.21%), and recurrence of disease in four eyes (7.14%) out of 57 eyes with corneal dystrophy. DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases. It has become an automatic choice for diseases of the anterior cornea requiring keratoplasty. Complications can occur at any stage of surgery; however, if identified and managed early, they can result in optimal outcome.

Outcome of Lamellar Graft Patching for the Treatment of Noninfectious Corneal Perforations.

The aims of this study were to evaluate the clinical outcome of lamellar graft patching used for treating noninfectious corneal perforations and to determine the clinical factors affecting tectonic integrity. This retrospective study includes a total of 71 eyes of 67 patients who underwent lamellar graft patching for the treatment of corneal perforations due to persistent epithelial defects secondary to limbal stem cell deficiency (LSCD, 21 eyes; 29.6%), peripheral ulcerative keratitis (17 eyes; 23.9%), neurotrophic keratitis due to herpes simplex keratitis (HSK, 14 eyes; 19.7%), and other causes (19 eyes; 26.8%). We evaluated the tectonic integrity of the globe, visual outcomes, and postoperative complications. Tectonic integrity was achieved in 53 eyes (74.6%). The survival proportions of eyes that achieved clear grafts were 77.8% and 65.2% at 12 and 24 months, respectively. Graft failure was observed in 19 eyes (26.8%). The survival rate of tectonic integrity and eyes that finally achieved a clear graft was significantly worse in eyes with LSCD compared with those without ( P < 0.001). The logarithm of minimal angle resolution improved significantly from 1.79 ± 0.98 to 1.22 ± 0.87 at 12 months and 1.08 ± 0.81 at 24 months. Postoperative complications included cataract formation (32 eyes, 45.1%), intraocular pressure rise (23 eyes, 32.4%), recurrent perforations (15 eyes, 21.1%), infectious keratitis (14 eyes, 19.7%), recurrence of herpes simplex keratitis (7 eyes, 9.9%), and traumatic graft dehiscence (1 eye, 1.4%). Lamellar graft patching is an effective and safe surgical treatment for noninfectious corneal perforations; however, careful attention to severe complications is necessary, especially in eyes with LSCD.

Etiology, management of ptosis in working age group and its surgical outcome – A prospective study

To study the etiology of ptosis among 20 - 50 years of age and analyse the management and surgical outcomes of various types of ptosis using different surgical modalities. This prospective study was conducted at Tertiary Eye Care centre in Chennai from July 2018 - June 2019.It included all patients with ptosis between the age of 20 - 50 years after excluding vascular malformations and malignant tumours of the lid. Here all variables are described with frequency distribution and displayed using percentage. Incidence of congenital ptosis was 11 cases (37%), aponeurotic ptosis 8 cases (26%), myogenic ptosis 4 cases (13%), neurogenic ptosis 3 cases (10%), mechanical ptosis. 2 cases (7%), post traumatic ptosis 2 cases (7%). 70% were males and the remaining 30% were females. Among 30 cases, 23 patients had unilateral and 7 patients had bilateral ptosis. Moderate ptosis (3-4mm) (46.7%) formed a major composition of our study shortly followed by severe ptosis (43.3%). Out of 30 cases, 9 cases were managed medically (30%) and surgical intervention was required in 21 cases (70%). Out of 7 bilateral ptosis, 2 cases were managed medically and 5 cases needed surgical intervention. Complications following frontalis sling were under correction (27.3%) in 3 cases followed by mild corneal exposure keratitis (9.1%) in one patient. Complications following levator advancement were under correction in one case (12.5%) and mild lid peaking in one case (12.5%). Among 2 cases of mechanical ptosis, one was squamous papilloma and other was a large chalazion. Out of 4 myogenic cases 3 cases were due to myasthenia and the other diagnosed to have CPEO. 2 cases of traumatic ptosis were due to traumatic 3rd nerve palsy and traumatic levator dehiscence. The most common acquired ptosis was aponeurotic followed by myogenic, neurogenic, traumatic and mechanical ptosis. Frontalis sling surgery is the most common surgery done for congenital ptosis. Use of polypropylene as a suspensory material gives a good functional outcome. Aponeurotic advancement surgery is the most common surgery performed for acquired ptosis.

New sign of anterior zonular dehiscence

A new anterior capsule sign was encountered at the time of phacoemulsification surgery in an eye that had previously sustained blunt trauma. A combination of traumatic dehiscence of the anterior zonular fibers, dehiscence between the lens and capsular epithelium, and recumbency at the time of surgery is posited to be the cause of the appearance. To the authors' knowledge, this is the first reported instance of this sign.

Traumatic Corneal Dehiscence After Penetrating Keratoplasty.

Traumatic Corneal Dehiscence After Penetrating Keratoplasty.

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

PurposeTo compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.MethodsRetrospective 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.ResultsOf 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).ConclusionPost-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.

An unusual cause of pneumoperitoneum—Traumatic vaginal dehiscence six months after hysterectomy

Introduction: Intraperitoneal free air usually results of the perforation of a hollow viscus. A high degree of suspicion based on previous medical history can identify a gynecologic origin.

Subcutaneous ICD–A North Queensland Experience

Introduction: Subcutaneous implantable cardioverter defibrillators (S-ICD) are an attractive option over traditional transvenous devices as they avoid vascular complications, use less fluoroscopy, and avoid intra-cardiac leads. Their availability is increasing globally and we present our experience in North Queensland. Methods: We performed a retrospective review of patients who had an S-ICD inserted in Townsville Hospital. Hospital records and implant details were reviewed. Results: 12 patients had S-ICD implantation between January 2015 and February 2017. Mean age of 42(18-66), with 8 males. Indications included hypertrophic cardiomyopathy (3/12), channelopathies (3/12), idiopathic cardiomyopathy (3/12), ischaemic (2/12) and non-compaction cardiomyopathy (1/12). 7/12 were for primary and 5/12 for secondary prevention. All patients had QRS durations <120ms, no documented bradycardia, and an average LVEF of 46%. All procedures were done under GA using a 3-incision technique with 10 patients having satisfactory defibrillator threshold (DFT) testing. In two, DFT were contraindicated from the presence of intra-cardiac thrombus. Mean procedure time was 87mins (95%CI 53-121mins), with an average radiation dose of 20mGr. There were no peri-procedural complications and all were discharged within 48 hours post implantation. At an average of 9 months follow-up, there were no device related events, one traumatic dehiscence requiring pocket revision, one ED presentation with implantation site pain and no deaths. Conclusion: S-ICD is a safe and viable treatment for prophylaxis against sudden cardiac death. Our experience reveals excellent patient outcomes and support current evidence for its increasing use in a variety of cardiac diseases for the North Queensland community.

Incidence, severity and outcomes of traumatic wound dehiscence following penetrating and deep anterior lamellar keratoplasty

BackgroundWound dehiscence is an uncommon but significant complication following keratoplasty. This study analysed the incidence, risk factors, clinical features and outcomes of traumatic wound dehiscence following keratoplasty.MethodsRetrospective case series at...

Role of SD‐OCT in the diagnosis and management of a late‐onset corneal LASIK flap tear secondary to screwdriver trauma

AbstractPurpose Traumatic flap displacement is a known possible complication after LASIK. It occurs most commonly in the first 24 h following surgery in approximately 1%‐2% of cases. However, late flap dislocations have also been reported. We present a case of traumatic flap displacement occurring four years after the initial LASIK surgery.Methods Interventional case report showing the role of spectral domain optical coherence tomography (SD‐OCT) in the management of the LASIK flap dislocation.Results A 29‐year‐old man presented with blurred vision, photophobia, and pain after trauma to his left eye caused by a screwdriver. He had a history of moderate myopia and had undergone uneventful bilateral LASIK 10 years previously. On examination, he had a 180‐degree traumatic corneal flap dislocation with an inverted tear in the temporal cornea. We performed a precise exploration by SD‐OCT after repositioning the corneal flap and a disposable contact lens, used as a therapeutic bandage, was placed on the cornea. Topical antibiotics and glucocorticoids were administered. One month postoperatively, his previous visual acuity had recovered and the dislodged flap showed an epithelial ingrowth, which did not require removal.Conclusion Early recognition, precise control by SD‐OCT and reposition the flap along with hydrating the flap together with a contact lens, topical antibiotics and steroids may be a good treatment option. Late traumatic flap dehiscence is a rare complication which demonstrates the vulnerability the flap‐bed stromal interface how a potential zone of weakness for many years following the procedure. Patients should be advised to visit ophthalmologist for injury after LASIK.

Rotational Autokeratoplasty in Pediatric Patients for Nonprogressive Paracentral Corneal Scars

To report the outcomes of ipsilateral rotational autokeratoplasty (RAK) for nonprogressive paracentral corneal opacities in children <16 years of age. Retrospective, consecutive, interventional case series. Thirty-three eyes of 33 children aged <16 years undergoing RAK for nonprogressive paracentral scars. Medical records were retrospectively reviewed for the primary etiology of corneal opacity, time of onset, duration of opacity, preoperative visual acuity, formula used for calculation of trephine size, size of the trephine used, and duration of follow-up. Any intraoperative and early and late postoperative complications were noted for all patients. Postoperative visual acuity and astigmatism were noted. Visual acuity was converted to logarithm of the minimum angle of resolution units for analysis. Primary outcome was postoperative visual acuity. Graft clarity and complications were analyzed as secondary outcomes. The mean age at surgery was 7.2 ± 3 .9 months. The mean follow-up duration was 27 ± 37 months. The commonest etiology of corneal opacity was trauma (62.5%), followed by resolved microbial keratitis (21.9%). Postoperative visual acuity (1.25 ± 0.84) was significantly better (P<0.001) than preoperative visual acuity (2.05 ± 0.96). The mean astigmatism at last visit was 4.04 ± 2.21 diopters. Postoperative visual acuity was better in older children (β = -0.01; P = 0.03) and had a shorter delay in presentation (β = 0.02; P = 0.05). At the last follow-up, the graft was clear in 27 cases (81.25%). The cumulative probability of graft survival was 85% at 2 years and 65% at 5 years. Complications included wound leak in 4 eyes, secondary glaucoma in 2 eyes, graft infiltrate and traumatic dehiscence in 1 eye each. Rotational is a autokeratoplasty viable alternative surgical option to allogenic keratoplasty. Graft survival at 2 years seems to be better than allogenic keratoplasty. Younger age and delay in presentation contribute to poorer visual outcomes after surgery. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Protective effect of LASIK flap in penetrating keratoplasty following blunt trauma

Penetrating keratoplasty (PKP) often results in large and unpredictable refractive errors following suture removal in the postoperative period. Laser in situ keratomileusis (LASIK) is an effective means of correcting these errors. However, LASIK following PKP is believed to further weaken an already weak graft-host junction and may predispose such eyes to traumatic dehiscence of the graft-host junction. We describe a case in which the LASIK surgery following PKP seemed to benefit the patient by preventing complete dehiscence of the graft-host junction.

Serial Excision of Facial Hemangiomas

To present the technique of and indications for serial excision of facial hemangiomas. Clinical review of patients cared for by the senior author (M.H.) in a private-practice specialty center. Forty-six patients underwent serial excision of facial infantile hemangiomas. The average number of excisions was 3 (range, 2-5), with a mean interoperative period of 4 months (range, 3-7 months). One patient sustained a traumatic dehiscence of the surgical wound, and 6 others had minor wound problems that had no impact on the final result. Two "final" scars underwent surgical revision. All results were ultimately deemed acceptable by the parents and surgeons. Serial excision is a practical and reliable technique for treatment of facial hemangiomas which due to size and location are not feasibly excised and repaired in a single setting without the use of complex adjunctive reconstructive techniques.

Déhiscence traumatique du globe oculaire après greffe de cornée

To assess the patient characteristics, risk factors, and outcomes of penetrating keratoplasty wound dehiscence. Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of penetrating keratoplasty wound dehiscence from January 1986 to January 2006 in the Ophthalmology Department at the Besançon Minjoz Hospital (France). The mean time between penetrating keratoplasty and wound dehiscence was 3.3 years (range, 1-140 months). In all cases, dehiscence involved the junction between graft and host. The mean age at time of wound dehiscence was 47 years (range, 23-89 years). Falls were the most common mechanism of trauma, especially in the elderly population. There was a wide range of visual outcomes in the 11 patients, with six patients with best corrected visual acuity less than 1/20. There were no cases of endophthalmitis. Patients with corneal transplants have a life-long risk for wound traumatic dehiscence. This complication may be reduced by the regular use of eye protection by all corneal transplantation patients.

Traumatic Dehiscence of Medtronic Freestyle Stentless Bioprosthesis

We report a case of deceleration injury causing traumatic dehiscence of a Medtronic Freestyle aortic bioprosthesis (Medtronic Inc, Minneapolis, MN) in a 70-year-old patient 5 years after a total root reconstruction. The patient presented with progressive exertional dyspnea 6 months after a significant impact during a hockey game. Intraoperatively, there was a posterior dehiscence of the proximal suture line and almost complete tear of the left coronary leaflet. At reoperation, the patient underwent reconstruction of the aortic root and Bentall procedure with a size 23 mechanical aortic valved conduit.