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oualid GUECHI, Jean-Marc Perone, Adina Agapie, Oana Gheorghe, Agathe Ferte, Ioana Botez, Pierre-Jean Bertaux; Spontaneous wound dehiscence after removal of combined penetrating keratoplasty suture. Retrospective study about 71 cases. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6054.
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To determine the incidence of spontaneous wound dehiscence after removal of a combined (continuous and interrupted) penetrating keratoplasty (PK) suture.
234 eyes were operated for KR with combined suture (continuous and 4 interrupted suture) by the same surgeon between 2003 and 2010. The authors realized a retrospective review of the 71 combined suture removal (30.34%) and try to describe cases of spontaneous wound dehiscence after suture removal and possible associated complications.
Seventy-one (30.34%) of 234 PKs reviewed had a combined suture removal. The mean age of the 71 patients was of 65.59 +/- 30 years (range 25-96 years) and there where 35 men (49.9%) and 36 women (50.7%). The mean interval for suture removal after PK was 18.7 +/- 12 months (range, 12-45 months). Four of the 71 eyes (5.6%) developed spontaneous wound dehiscence without any history of associated traumatism. The mean age of the four patients was of 67.2 +/- 20 years (range, 44-84 years). In the four eyes that developed wound dehiscence the removal of combined suture occurred at 15.3 +/- 10 months (range, 12-25 months) and dehiscence occurred at 12.2 +/- 7 days (range, 5-17 days) after suture removal. The reason for suture removal where astigmatism for all the four patients. Wound dehiscence was situated in superior zone and dehiscence corresponded at most to 90 degrees of surface. The indication of the PK for the four eyes where a corneal oedema for 3 cases (pseudophakic bullous keratopathy, aphakic corneal oedema and Fuch’s dystrophy) and corneal scarring for one case. Surgical intervention (interrupted suture) preserved the initial best corrected visual acuity for 3 patients and for the last one a new PK was necessary because of an associated endophtalmitis.
In this retrospective study, the rate of spontaneous wound dehiscence after combined PK suture in our 71 patients was 5.6% (4 patients). This rate is comparable with the rate of literature. All complications occurred in the first two weeks after suture removal, which suggest a close monitoring during this critical period. Adequate early surgery preserved best corrected visual acuity in the majority of cases.
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