Tseng S H, Lin S C, Chen F K
Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
Cornea. 1999 Sep;18(5):553-8.
To describe the characteristics, causes, treatment, and outcome, particularly the fate of the intraocular implant and visual acuity, of traumatic wound dehiscence occurring in patients who had penetrating keratoplasty (PK).
Between 1989 and 1997, 21 corneal transplant patients sustained traumatic wound dehiscence and were treated at our hospital. Graft dehiscence was managed with primary wound closure in all patients, except in some who required some combination of anterior vitrectomy, intraocular lens removal and reimplantation, and corneal regrafting.
The incidence of traumatic wound dehiscence among patients on whom we performed PK over a period of 9 years was 2.53%. This complication occurred, on average, 3.4 years (2 months to 13 years) after PK. Most patients (76%) were men, and the average age at dehiscence was 59 years (range, 15-82 years). All corneal ruptures occurred at the graft-host junction, which had neither particular site preference nor quadrant specificity. Of the 16 eyes that were pseudophakic, nine (56.3%) had either loss of implants or dislocation of intraocular lens so severe that lens removal was imperative. In the end, only five (23.8%) of the 21 grafts retained clarity. Of the remaining 16 eyes, seven were regrafted, of which five (71.4%) grafts remained clear. Of the nine grafts that became opaque, six eyes (28.6%) atrophied. At the last follow-up, only six eyes (28.6%) had visual acuity of 20/200 or better, and six eyes had no perception of light. Final visual acuity was found to correlate inversely with the severity and extent of wound separation.
Traumatic wound dehiscence is not rare after PK. The elderly corneal transplant patient may be more prone to such an injury. Corneal rupture at the graft-host junction in all of our cases means the persistence of wound weakness after PK. Although graft survival and visual outcome are generally poor after the injury, the restoration of a satisfactory visual result is possible after regrafting, insofar as the involved eye is free of intractable glaucoma or posterior segment damage.
描述穿透性角膜移植术（PK）患者发生外伤性伤口裂开的特征、原因、治疗及结果，尤其是眼内植入物的转归和视力情况。
1989年至1997年间，21例角膜移植患者发生外伤性伤口裂开并在我院接受治疗。除部分患者需要联合行前部玻璃体切除术、人工晶状体取出及再植入术和角膜再次移植术外，所有患者均采用一期伤口闭合处理移植伤口裂开。
在9年期间接受PK的患者中，外伤性伤口裂开的发生率为2.53%。该并发症平均发生在PK术后3.4年（2个月至13年）。大多数患者（76%）为男性，伤口裂开时的平均年龄为59岁（范围15 - 82岁）。所有角膜破裂均发生在植片与宿主的交界处，该部位无特定的位置偏好或象限特异性。在16只人工晶状体眼当中，9只（56.3%）出现植入物丢失或人工晶状体脱位严重到必须取出晶状体的情况。最终，21例植片中仅5只（23.8%）保持透明。其余16只眼中，7只接受了再次移植，其中5只（71.4%）植片保持透明。在9只变得混浊的植片中，6只眼（28.6%）发生萎缩。在最后一次随访时，仅6只眼（28.6%）视力达到20/200或更好，6只眼无光感。发现最终视力与伤口裂开的严重程度和范围呈负相关。
PK术后外伤性伤口裂开并不罕见。老年角膜移植患者可能更容易发生此类损伤。我们所有病例中角膜在植片与宿主交界处破裂意味着PK术后伤口仍存在薄弱环节。尽管受伤后植片存活和视力预后通常较差，但只要患眼没有难治性青光眼或眼后段损伤，再次移植后恢复满意的视力结果是有可能的。
