Clinical Outcomes Of Traumatic Graft Dehiscence Following Penetrating Keratoplasty And Deep Anterior Lamellar Keratoplasty

We present outcomes of consecutive cases of traumatic graft dehiscence (TGD) in cases of penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK). 

Moorfields Eye Hospital, London, United Kingdom.

Retrospective case series of consecutive cases of TGD presenting to a tertiary centre during the period 2021-2025. Our study cohort included 38 eyes of 37 patients of which 34 were PKPs and 4 were DALKs. The median age was 46.50 years (range 22, 83), with 71.05% being male. The median follow-up time (years) following surgical repair was 0.65 (0.00, 4.03). The median time to TGD following the original corneal graft surgery was 1.54 (0.08, 39.75). 

The median extent of graft dehiscence (clock hours) was 6 (1, 10), with 36.84% having no remaining sutures in situ at the time of trauma. The median visual acuity (logMAR) at presentation was 2.40 (0.50, 3.00). The median visual acuity pre and post trauma was 0.48 (-0.10, 2.40) and 1.30 (0.10, 3.00), respectively (p<0.0001). Anterior vitrectomy was performed in 39.47% of cases at the time of surgical repair. Lens extrusion occurred in 48.65% of phakics and intraocular lens subluxation occurred in 25.00% of pseudophakics. Retinal detachment occurred in 15.79%, suprachoroidal haemorrhage in 13.16%, and choroidal effusion in 2.63%. Graft failure occurred in 25.71%, with 18.91% of eyes requiring a new corneal transplant.

Traumatic graft dehiscence is a sight-threatening emergency, can occur decades after original surgery, and is associated with significant complications. Patient counselling to avoid ocular trauma is essential to minimise future risk.