Outcomes of Wound Dehiscence Post Penetrating Keratoplasty
Purpose
To analyze the characteristics, risk factors, and outcomes of patients with history of wound dehiscence post penetrating keratoplast
Methods
Thirty-one eyes of 30 patients with a history of open wound dehiscence post penetrating keratoplasty (PK) between January 01, 2009 and April 30, 2014 and followed by the Cornea department at Wills Eye Hospital were retrospectively analyzed. Data collected included patient demographics, indication for PK, time to wound dehiscence, causative events, dehiscence size, change in lens status, post dehiscence ocular complications, post-repair graft clarity, and visual acuity outcomes. Only patients who had surgical repair of an open wound dehiscence were included in this study. Patients with wound slippage but no aqueous leaks were excluded.
Results
The mean age at wound dehiscence was 56±22 years. The mean time from penetrating keratoplasty to wound dehiscence was 9.8±9.5 years. Twenty six eyes (81%) sustained trauma-induced dehiscence while 4 had unknown causation and 1 did not indicate trauma at visit. The mean size of dehiscence was 153±66 degrees. Visual outcomes ranged from 5 patients achieving best vision between 20/50-20/100 and 2 patients with NLP vision post dehiscence. Twenty eyes (76%) sustained loss of crystalline or implanted lens at dehiscence. Of the pseudophakic patients, the 5 who retained their lens implant had a better visual outcome (20/400) than the 10 who did not (20/800).
Conclusion
Wound dehiscence is a life-long risk that all PK patients face regardless of age, indication for surgery, and time since transplant. Although visual outcomes are difficult to predict due to the many factors involved, some indications such as lens status and smaller dehiscence size may suggest better visual outcome potential.