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Late onset post-keratoplasty wound dehiscence masquerading keratoconus recurrence
Session Title: Cornea Surgical II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 09:22
Venue: Forum (Ground Floor)
First Author: : E.Albe ITALY
Co Author(s): : R. Barbara S. De Angelis B. Ricci-FIlipovic M. Busin
To evaluate the characteristics and the surgical treatment of late onset post-penetrating keratoplasty (PK) wound gaping, masquerading as keratoconus recurrence in patients with high-degree astigmatism and clear post-PK graft.
Prospective study. All procedures were performed by the same surgeon (M.B.) at Eye Department of private hospital "Villa Igea" in Forli, Italy.
Six patients were referred to our department because of the late onset of progressive high-degree irregular astigmatism following PK for keratoconus, diagnosed as keratoconus recurrence. Instead, in all cases inferior gaping of the old PK wound had occurred, causing high-degree astigmatism against the rule.
Corneal topography, best spectacle-corrected visual acuity (BSCVA), refraction and anterior segment OCT were assessed before and 1, 3, 6, and 12 months after surgery.
Each eye underwent realignment of the PK gaping wound by means of a procedure including: a. Removal of the epithelium; b. Opening of the PK wound for the entire length of the dehiscence; c. Proper apposition and suturing of the wound margins with single 10-0 nylon stitches. All sutures were removed within 6 months from surgery
Wound dehiscence had occurred 22.3+9.5 years in average after PK. Following complete suture removal, i.e. 6 months after wound revision , BSCVA had improved in all eyes from <20/200 to >20/40; mean topographic cylinder was reduced from 12.5± 3.2 diopters (D) to 4.2 ± 2.7 D (p=0.0022). Post-revision OCT showed good apposition of donor and recipient margins of the PK wound.
No substantial change was seen at later examinations. No early or late complications were seen. Endothelial cell loss measured 6 months after wound revision averaged 12.2%.
Late onset dehiscence of PK wounds causing high-degree astigmatism may masquerade post-PK keratoconus recurrence. Slit-lamp examination and OCT evaluation are instrumental in properly diagnosing the true cause of late changes in post-PK corneal curvature .
Wound re-alignment is a simple, causative treatment to avoid repeat PK in these eyes. Limited cell loss allows this procedure to be performed safely even in eyes with fair endothelial density.