Purpose
To compare outcomes of patients with traumatic dehiscence of penetrating keratoplasty (PK) to those with severe open globe (OG) injuries.
Methods
A retrospective review of 160 consecutive patients with surgical repair of traumatic open globe injuries at a single center from 2006 to 2012 was conducted. Of those, 36 patients underwent repair of dehisced PK, 16 of which had adequate data to calculate the Ocular Trauma Score (OTS). OTS was calculated for the remaining non-PK open globes, resulting in 34 eyes with OTS of similar severity. Ophthalmic and demographic factors were analyzed using t-tests, Pearson correlation coefficients, chi squared tests, and Fisher’s exact test.
Results
There was a trend of patients with dehisced PK being older than the OTS-matched patients with OG injuries (60 vs.48; p=0.06). In the overall cohort, older age correlated weakly with lower OTS (r= -0.4, p=0.008). There was no correlation between sex and OTS (p=0.20). Associated lens injury at the time of initial trauma was more common in the PK group (p=0.03), but was not significantly associated with poor OTS (p=0.18). The extent of the ocular laceration was not significantly different between the groups (p=0.22). Of the 40 patients with postoperative follow-up, 10 required subsequent enucleation - 1 from the PK group and 9 from the OG group (p=0.12). Of the remaining 30 patients, 67% required surgery beyond the initial repair. Additional surgeries were similarly likely in both groups (p=1.00). Two patients developed endophthalmitis, 1 from each group. Patients with dehisced PK required subsequent cornea surgery more often than those with OG injuries (p=0.0025), but had similar rates for subsequent retina, glaucoma, and lens surgeries (p=0.12, p=0.55, p=0.23, respectively). The mean final visual acuity of the PK group was 20/400 versus 20/100 in the OG group, but this was not statistically significant (p=0.13).
Conclusions
In this study, patients with traumatic dehiscence of PK were compared to those with OG injuries with similar Ocular Trauma Scores. Both groups had poor visual outcomes, often required multiple surgeries, and in some cases resulted in enucleation. No significant differences in outcomes were detected between patients with dehisced PK wounds versus those with severe OG injuries.
Keywords: 479 cornea: clinical science •
742 trauma •
765 wound healing