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F. Orucov, J. Vicuna-Kojchen, D. Landau, J. Frucht-Pery, A. Solomon; Traumatic Wound Dehiscence After Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4690.
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To assess the patient characteristics, incidence, risk factors, and clinical outcome of traumatic wound dehiscence after penetrating keratoplasty.
Retrospective chart review of 15 eyes (14 patients) with traumatic wound dehiscence after penetrating keratoplasty between January 1996 and August 2006, who were operated and managed at the Cornea Service in Hadassah Medical Center.
Of 789 penetrating keratoplasties that were performed between January 1996 and August 2006, 15 eyes (1.97%) of 14 patients had traumatic wound dehiscence. Eleven eyes were operated for keratoconus, 3 eyes had trachoma, and one had corneal graft for a traumatic scar. The mean time from penetrating keratoplasty to trauma was 33 months (range 2 weeks to 16 years). The mean age at time of wound dehiscence was 37 years (range 18-81 years) with a bimodal distribution (12 eyes between years 11 to 40, and the remaining 3 eyes between years 60 to 90). Falls (46.6%) and playing accidents among children (40%) were the most common mechanism of trauma. Home (80%) was the most common place for trauma to occur. All corneal ruptures occurred at the graft-host interface. There was no particular location preference for wound rupture. Vitreous and lens loss were noted in 11 eyes (73%) and retinal complications occurred in 3 eyes (20%).The first surgical procedure included primary wound closure in all eyes, combined with anterior vitrectomy in 7 eyes, and posterior vitrectomy in one eye. A second surgical intervention for retinal complication was needed in 3 eyes. Eight grafts remained transparent, 2 grafts remained edematous, 4 eyes were re-grafted, and one eye was re-grafted twice. One eye went to phthisis. After one year of follow-up, the mean loss of BCVA was 5 lines, one patient had light perception, and 2 patients had no light perception.
Patients with corneal transplants have a life-long risk for wound dehiscence. Traumatic wound dehiscence is more prevalent in younger patients, who had penetrating keratoplasty for Keratoconus. The visual outcome after this occurrence is usually poor. Patients must be continuously educated as to the risk of wound rupture after penetrating keratoplasty and as to the necessary precautions.
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