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J. S. Brown, M. Slabaugh, M. Wu, J. J. Lee; Open Globe Injuries Following Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2311.
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© ARVO (1962-2015); The Authors (2016-present)
To review the demographics, mechanism, and outcome of patients with penetrating keratoplasty (PK) who sustain open globe injuries.
Retrospective review of medical records from a major tertiary referral center between 11/98-11/06 of patients with open globe injuries and a history of PK in the traumatized eye.
31 patients were treated through the University of Washington between 1998 and 2006 who had a prior PK at the time of an open globe injury. The mean age at the time of injury was 54 (range, 20-96). 11 (36%) were female and 20 (65%) were male. The primary indication for the initial PK was previous trauma in 9 (29%), endothelial failure in 7 (23%), keratoconus in 4 (13%), congenital corneal opacity in 2 (7%), HSV keratitis in 2 (7%), and unknown in 7 (23%). The globe trauma was the result of an accident in 23 (75%) (13 (42%) from a fall), assault in 6 (19%), and self-induced in 2 (7%). Of patients who suffered injury from accidental falls the average age was 71 (range 20-96). The Graft did not contain any sutures in 24 (77%) and the mean age of the corneal transplant was 11 years 2 months (range, 3 months to 30 years). When obtainable, initial visual acuity ranged from 20/200 to NLP, with 96% (24/25) worse than hand motion. Alcohol was involved in the trauma in 6 (19%) patients. The location of the globe injury was at the graft host junction in all but 2 cases. Before the trauma 14 patients were known to be pseudophakic of which 11 (79%) had extrusion of the lens. Similarly, 6 patients were known to be phakic and 4 (67%) had extrusion of their crystalline lens. At the last follow-up in 18 cases followed long-tem (average follow-up 22 months), vision was 20/100 or better in 3 patients (17%), HM or worse in 8 patients (45%) and 6 eyes had been enucleated. 11 (61%) developed a retinal detachments and 2 (11%) developed glaucoma. For those patients not enucleated the traumatized graft opacified in 8/11 (73%) and was clear in 3/11 (27%) at the last follow-up.
PK confers a life-long inherent weakness to the eye increasing the likelihood of a globe rupture from even minor trauma. Interestingly globe injury in patients with prior PK does not always involve the graft-host junction. The prognosis from an open globe in eyes with a PK is very poor. Therefore it is important to continue to seek alternatives to PK such as lamellar corneal transplantation and to scutizie the need for PK in high risk patients such as those who are engrafted because of a prior history of trauma.
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