Abstract
Purpose :
To compare patient characteristics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following penetrating keratoplasty and deep anterior lamellar keratoplasty.
Methods :
A retrospective review was undertaken of all patients presenting with post-keratoplasty wound dehiscence at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia between 2005 and 2017. Keratoplasty techniques other than penetrating keratoplasty and deep anterior lamellar keratoplasty were excluded, as were patients with insufficient clinical data. Continuous and categorical variables were compared between traumatic and non-traumatic dehiscence patients using the Wilcoxon rank sum test and Fisher’s exact test, respectively
Results :
Seventy-one eyes from 71 patients were included, 44 (62%) of whom were male. The mean age was 56.4 years (SD=22.7, range = 17.6 – 97). There were 28 (39.4%) cases of traumatic dehiscence and 43 (60.6%) cases of non-traumatic dehiscence. There were 60 (84.5%) penetrating keratoplasty patients and 11 (15.5%) deep anterior lamellar keratoplasty patients. The timing of dehiscence ranged from <1 year to 41 years post keratoplasty.
The median time interval from keratoplasty to dehiscence was significantly less in non-traumatic patients than traumatic patients (0.2 years, IQR=0.1-2.0 vs 2.3 years, IQR=0.3-14.8, P = 0.01). Non-traumatic patients had worse pre-dehiscence best corrected visual acuity compared to traumatic patients (vs 6/60, IQR 6/19 – count fingers vs 6/18, IQR 6/9 - <6/60, P = 0.014) but there was no significant difference in best corrected visual acuity at six months (6/60 vs 6/36, P = 0.62). There was no difference in the indication for corneal grafting, suture technique, suture removal or type of keratoplasty technique (penetrating keratoplasty vs deep anterior lamellar keratoplasty) between traumatic and non-traumatic patients (P = 0.115).
Conclusions :
Wound dehiscence is a serious complication following penetrating keratoplasty and deep anterior lamellar keratoplasty. While the risk of dehiscence is lifelong, the first three years post keratoplasty are the highest risk, with non-traumatic dehiscence tending to occur earlier than traumatic dehiscence. Patients of traumatic dehiscence had worse visual outcome at six months post-dehiscence but this was not statistically significant.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.