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Outcomes of traumatic wound dehiscence following penetrating keratoplasty and deep anterior lamellar keratoplasty: an Indian scenario

Poster Details

First Author: T.Chowdhury INDIA

Co Author(s):    A. Pradhan   N. Das   M. Das              

Abstract Details

Purpose:

Penetrating Keratoplasties (PKP) and Deep Anterior Lamellar Keratoplasties (DALK) always carry a risk of development of wound dehiscence at graft host junction (GHJ) and that can lead to sight threatening consequences. To better understand the risk factors, we analysed the characteristics, clinical features and outcomes of a series of patients with post - PKP/ DALK wound dehiscence.

Setting:

Disha Eye Hospitals Private Limited, Kolkata, India

Methods:

Data were collected retrospectively at a tertiary eye hospital in Eastern India. 24 eyes of 22 patients with wound dehiscence from March 2009 till July 2016 were included in this study. 22 eyes with PKP and 2 eyes with DALK had wound dehiscence. In DALK cases there was no aqueous leak, but one patient came after 21 days with graft infiltrate and ultimately required therapeutic PKP. Patients having minimum follow up of 6 months following wound repair were included in this study.

Results:

Out of 22 patients, only 4 were female. Out of 24 eyes, 8 eyes had keratoconus, 4 eyes had corneal dystrophy, 3 eyes had pseudophakic bullous keratopathy and 9 eyes had corneal scar following healed infectious keratitis. All eyes had trauma induced dehiscence and occurred at a median of 19 months (range 11 weeks to 52 months) following keratoplasty and most frequently within first 9 months. The median size of wound dehiscence was 125 degrees (40 - 280 degrees). Visual outcomes ranged from 6/18 to no light perception with a majority between 6/60 to 6/120.

Conclusions:

Wound dehiscence is a life long risk after PKP or DALK irrespective of age, indication for corneal grafting and time since transplant. It may occur even following minor trauma. In this series the wound dehiscence mostly found within 9 months of surgery, so first one year is most crucial. In most cases visual outcome is poor and patients should be advised of this life long risk and a protective eye-wear should always be encouraged. A better visual outcome was associated with less degrees of wound dehiscence, retained lenses, better corneal graft clarity at presentation and early management.

Financial Disclosure:

NONE

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