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N. R. Benitah, M. T. Andreoli, R. Wee, C. M. Andreoli; Outcomes of Penetrating Keratoplasty Following Open Globe Repair. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1958.
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Patients with a history of open-globe repair surgeries may go on to require penetrating keratoplasty for a variety of reasons, including direct penetration of the cornea, corneal infections, and complications from other required surgeries (such as pseudophakic bullous keratopathy). Here we attempt to analyze the visual acuity outcomes and rates of corneal graft failure of patients who have had penetrating keratoplasty after globe rupture.
Charts of 692 patients presenting to the Massachusetts Eye and Ear Infirmary (MEEI) with globe rupture between July 1998 and August 2007 were retrospectively reviewed. Data regarding patient demographics, mechanism and zone of injury, initial and most recent visual acuities, and graft failure were collected and subsequently analyzed.
Of 692 patients presenting to the MEEI Emergency Ward with globe rupture, twenty-seven (4%) went on to require penetrating keratoplasty within our follow-up period. Of these twenty-seven patients, patient age ranged from 24-78, with a mean age of 42. Mechanisms of injury were blunt trauma in 6, projectile in 5, wood in 4, nail penetration in 3, sports related in 2,a fall in 1, and a motor vehicle accident in 1. Fifteen of these patients (56%) had zone I lacerations (some of whom also had zone II and/or III lacerations). Of patients with a presenting visual acuity recorded, 25/26 eyes (96%) were no better than counting fingers. At the time of latest follow-up after penetrating keratoplasty, seven of eighteen eyes (39%) had a BCVA better than 20/200, three of which (17%) had a BCVA of 20/40 or better, but 9/18 (50%) patients were no better than counting fingers. Four of eighteen patients (22%) on whom such data could be found had experienced failure of their graft.
Penetrating keratoplasty is not an uncommon corrective surgery needed by patients who have suffered an open globe injury. As such, it is important to have data available to patients and surgeons regarding the outcomes of such surgeries. The visual outcome in most cases is better than the presenting acuity, and in some cases excellent, but the prognosis must remain guarded. Furthermore, patients should be cautioned that roughly one in five grafts may be expected to fail under these circumstances. By setting realistic expectations, surgeons may better counsel patients with corneal compromise secondary to a ruptured globe on their best course of action.
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