Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

Yeon Soo Kang; Hyo Seok Lee; Won Choi; Kyung Chul Yoon

doi:10.3341/jkos.2016.57.4.568

Journal List > J Korean Ophthalmol Soc > v.57(4) > 1010552

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Kang, Lee, Choi, and Yoon: Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

Original Article

J Korean Ophthalmol Soc 2016;57(4):568-574.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.568

Clinical Manifestations and Prognosis of Traumatic Wound Dehiscence after Penetrating Keratoplasty

Yeon Soo Kang, MD, Hyo Seok Lee, MD, Won Choi, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: 82-62-220-6741, Fax: 82-62-227-1642 E-mail: kcyoon@jnu.ac.kr

Received 12 November 2015 Revised 8 February 2016 Accepted 21 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate clinical manifestations and prognosis of traumatic wound dehiscence after penetrating keratoplasty (PKP).

Methods

This is a retrospective study of patients with traumatic wound dehiscence after penetrating keratoplasty performed between January 2004 and July 2014. All patients underwent primary repair of wound dehiscence. Main outcome measurements included pre- and post-injury best corrected visual acuity (BCVA), mechanism of injury, indication of PKP, time interval from PKP to injury, time interval from injury to primary repair, extent of dehiscence, type of suture, presence of suture, prolapse of intraocular tissue, secondary operation, BCVA and graft state at 6 months after primary repair.

Results

The incidence of traumatic wound dehiscence after PKP was 3.96% (12/303). Mean post-injury BCVA and BCVA at 6 months after primary repair (log MAR) were 2.58 ± 0.95 and 2.50 ± 1.05, respectively, and visual acuity did not show significant improvement (p = 1.000). After primary repair, graft failure developed in 9 patients (75%) and evisceration in 2 patients; re-PKP was performed in 3 patients. Pars plana vitrectomy was performed in 1 patient due to retinal detachment. Visual prognosis was poor in patients with wound dehiscence greater than 180° than those with wound dehiscence less than 180° (3.24 ± 0.13 vs. 1.97 ± 1.11, p = 0.030), and in patients with iris prolapse than those without iris prolapse (3.17 ± 0.16 vs. 1.56 ± 1.05, p = 0.048).

Conclusions

The prognosis of traumatic wound dehiscence after PKP was poor, and the visual prognosis was less favorable in cases with wound dehiscence greater than 180° and iris prolapse. Therefore, prevention of ocular trauma should be emphasized in all patients who undergo PKP.

Keywords: Penetrating keratoplasty, Traumatic wound dehiscence, Visual prognosis

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Figure 1.

Slit lamp photography of a 71-year-old male. (A) Good graft state after penetrating keratoplasty. (B) Traumatic wound dehiscence with intraocular lens prolapse after being struck by a door. (C) Post operative state of primary repair.

Table 1.

Clinical characteristics of patients before primary repair

Patient No.	Age (years)	Sex	Laterality	Mechanism of injury	Indication of PKP	Time interval between PKP and injury (months)	Pre injury BCVA	Post injury BCVA	Presence of sutures	Extent of dehiscence (°)	Prolapsed tissue
1	45	Male	OS	Slip down	HSK	108	L.P (+)	L.P (-)	Removed	270	Iris
2	48	Male	OS	Struck by tree	HSK	120	0.3	H.M	Removed	180	Iris, Crystalline lens, Vitreous, Retina
3	60	Male	OD	Slip down	Corneal ulcer	48	F.C 30 cm	H.M	Removed	330	Iris
4	40	Female	OS	Slip down	HSK	108	0.2	0.15	+	90	−
5	71	Male	OD	Struck by door	PBK	1	F.C 50 cm	L.P (+)	+	120	IOL
6	52	Male	OS	Struck by steel	Corneal ulcer	120	0.1	H.M	Removed	120	−
7	64	Male	OD	Struck by tree	PBK	2	0.2	0.1	+	60	−
8	55	Male	OS	Slip down	HSK	144	0.1	H.M	Removed	120	Iris
9	74	Female	OS	Struck by tree	Corneal dystrophy	24	0.5	0.06	Removed	150	−
10	65	Female	OS	Struck by head	HSK	84	H.M	H.M	+	120	Iris, Vitreous, Retina
11	49	Male	OD	Struck by door	Corneal ulcer	121	0.1	H.M	Removed	180	Iris
12	58	Male	OD	Struck by hand	PBK	16	0.04	L.P (+)	+	240	Iris, IOL, Vitreous, Retina

PKP = penetrating keratoplasty; BCVA = best corrected visual acuity; OS = oculus sinister; OD = oculus dexter; HSK = herpetic simplex keratitis; PBK = pseudophakic bullous keratopathy; L.P = light perception; H.M = hand movement; F.C = finger count; IOL = intraocular lens.

Table 2.

Clinical characteristics of patients after primary repair

Patient No.	Time interval between injury and repair (hours)	BCVA at 6 months after repair	Graft status at 6 months after repair	Secondary operation
1	6	L.P (-)	Failure	Evisceration
2	3	L.P (+)	Failure	−
3	10	L.P (-)	Failure	PPV
4	7	0.06	Success	−
5	48	0.02	Success	−
6	31	L.P (-)	Failure	Evisceration
7	22	0.02	Failure	Re-PKP
8	8	H.M	Failure	−
9	12	0.2	Success	−
10	4	H.M	Failure	Re-PKP
11	4	H.M	Failure	Re-PKP
12	4	L.P (+)	Failure	−

BCVA = best corrected visual acuity; L.P = light perception; PPV = pars plana vitrectomy; PKP = penetrating keratoplasty; H.M = hand movement.

Table 3.

Comparison of visual acuity (log MAR)

Group	Postoperative BCVA	p-value^*
Age ≤ 55	2.68 ± 0.78	0.394
Age > 55	2.06 ± 1.32
Suture (+)	2.02 ± 1.08	0.268
Suture (-)	2.84 ± 0.96
Iris prolapsed (+)	3.17 ± 0.16	0.048
Iris prolapsed (-)	1.56 ± 1.05
Extent of dehiscence < 180°	3.24 ± 0.13	0.030
Extent of dehiscence ≥ 180°	1.97 ± 1.11
Time interval from PKP and injury ≤ 100 months	2.13 ± 1.22	0.394
Time interval from PKP and injury > 100 months	2.86 ± 0.78
Time interval from injury and repair ≤ 10 hours	2.88 ± 0.71	0.432
Time interval from injury and repair > 10 hours	1.96 ± 1.28

Values are presented as mean ± SD unless otherwise indicated.

log MAR = logarithm of the minimum angle of resolution; BCVA = best corrected visual acuity; PKP = penetrating keratoplasty.

^* Mann-Whitney U-test.

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