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Michael Shaw, Jaswant Sandhu, Francisco Figueiredo; Retrospective case series of clinical outcomes associated with globe trauma in corneal graft patients. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1334.
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© ARVO (1962-2015); The Authors (2016-present)
To report the incidence, mechanisms, characteristics, and outcomes of globe trauma in corneal graft patients including Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).
A consecutive retrospective case series review of all patients having undergone PK, DALK and DSAEK and experienced globe trauma between 1997 – 2017 under the care of a single surgeon at a tertiary hospital in the United Kingdom. Main outcome measures: original indication for grafting and type, incidence, demographics, time from surgery to trauma, mechanism of trauma, best corrected visual acuity (BCVA) and graft status pre and final post trauma and complications.
Twenty-one patients experienced one episode of globe trauma, and one patient two episodes in the same eye. At initial graft mean age was 53.4 years (SD 20.7), twelve (57.14%) were male and all 21 cases were PK. Mean age at trauma was 56.9 years (SD 22.0). Original indication for PK was visual rehabilitation (n=19), and therapeutic post infection (n=2) cases.The incidence of globe trauma in this cohort (n=921) was 1.1 cases/year over the study period. The mean time from original surgery to trauma was 7.7 years (SD 2.5). The location of trauma was home in 63.6%, work 4.5% and unknown 31.8%. The mechanism included falls (39.1%), at home working (21.8%) or accidentally (17.4%), accidently blunt trauma by self (8.8%), assault (4.3%), during sleep (4.3%), and unknown (4.3%).The mean LogMAR BCVA pre and final trauma was 0.68, and 1.77 respectively, p = 0.001. The pre and final graft failure status was 13.6% and 63.6% respectively, p <0.05. Associated post-trauma complications: aphakia (n=11), iris damage (n=11), glaucoma (n =8), retinal detachment (n=7), hypotony (n=5), evisceration (n=2), cystoid macular oedema (n=1), significant irregular astigmatism (n=2), endothelial graft rejection (resolved; n=1), endophthalmitis (n=1).
This 20-years review study shows that globe trauma occurs most commonly in the home environment and most frequently due to accidental falls. Graft failure resulted in 63.6% of cases and a three-fold increase in BCVA < 6/60. Cornea transplant surgeons should offer better counsel to patients on risks associated with post graft globe trauma, potential ways to reduce it and post trauma associated complications including graft failure.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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