Wound dehiscence after keratoplasty, a matter of concern
First Author: A.Eslampoor IRAN
The purpose of this study was to evaluate the predisposing factors, causes, clinical features, complications and prognosis of patients with wound dehiscence after corneal transplantation in a tertiary referral center in Iran.
Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.Retrospective analysis
This study was performed on all records of patients with wound dehiscence diagnosis and history of corneal transplantation in Khatam Eye Hospital during the period of 2007-2018. Forty-five eyes of 45 patients who had sustained wound dehiscence after keratoplasty were reviewed. The indications of initial keratoplasty, surgical type, causes, occurrence time, the extent of the wound, treatment, and outcomes were recorded.
The study population consists of 31 males and 14 females aged between 8-79 years and a mean age of 37.55 ± 20.04 years. The indication for keratoplasty was keratoconus in 31 patients (68.9%) and corneal scar in 6 (13.3%). The type of transplantation was a full-thickness graft in 29 patients (64.4%) and lamellar in 16 (35.6%). In 35 cases (77.8%) the causative factor was trauma, followed by wound dehiscence after suture removal in 10 cases(22.2%). The time interval ranged from 1 day to 28 years, with a mean of 2.99±5.24 years. The most common site for wound dehiscence was supratemporal in the right eye (42.2%) and infratemporal in the left eye (20%). The final vision ranged from NLP to BCVAlog10 = -0.45. In the final exam, 66% of the subjects had the vision of CF and more and the best visual endpoint was VA 0.9. The lamellar graft cases had fewer serious complications than full-thickness grafts.We could not find any significant correlation between the type of keratoplasty, indications, type of injury and final visual outcome.
All patients who have undergone a corneal transplant are at a lifelong risk of wound dehiscence. In the vast majority of our cases wound dehiscence has occurred in the first 3 years after transplantation. Trauma is the leading cause of wound dehiscence, especially work-related traumas.