Traumatic Wound Dehiscence and Lens Extrusion after Penetrating Keratoplasty

To investigate the risk factors of wound dehiscence and lens extrusion following blunt trauma in patients with penetrating keratoplasty (PK) as well as the results of treatment. In a retrospective case series, 7 eyes of 7 patients including 6 male and one female subjects were investigated. All cases received primary care at the time of referral and then underwent secondary repair under general anesthesia in operation room setting. After evaluation of the wound, anterior vitrectomy was performed and secondary wound repair was done using nylon 10-0. Mean age of patients was 20.6±6.2 (range 10 to 30) years and mean interval between keratoplasty and trauma was 15.6±10.1 (range 2.5 to 26.5) months. Mean best-corrected visual acuity of patients before the trauma and at final follow-up was 0.6±0.38 logMAR (20/80) and 0.9±0.96 logMAR (20/160), respectively. In one case, visual acuity decreased to light perception after the final treatment. No case needed regraft. Most prevalent site of dehiscence was superior to the graft (4 cases) and the most prevalent cause of blunt trauma was hitting by hand. No case of endophthalmitis occurred. PK patients are susceptible to wound dehiscence due to trauma especially during the first postoperative year. This is more prevalent in young male subjects who are more prone to trauma because of higher social activities. Proper explanation of this problem for patients together with using protective eye shields as well as performing lamellar keratoplasty instead of PK if possible can decrease side effects of trauma in these patients.