Walker H G, Bennett L W, Brown J D
Ambulatory Care Service, James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee, USA.
J Am Optom Assoc. 1999 Dec;70(12):777-81.
Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury.
This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain.
After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.
穿透性角膜移植术后，由于移植片与宿主界面在术后数年仍较为薄弱，患者遭受钝性创伤时存在伤口破裂的风险。暴力环境、接触性运动和剧烈活动会使角膜结构完整性受损的患者面临较高的创伤性损伤风险。
本病例报告介绍了一名42岁的穿透性角膜移植患者，有流浪、多种物质滥用和家庭暴力史。该患者因被拳头直接击打，在移植片与宿主交界处发生眼球破裂，眼内晶状体被挤出眼外。紧急伤口闭合后，移植片持续退变，直至发展为大泡性角膜病变。鉴于该移植片几乎没有视觉恢复潜力，实施了冈德森结膜瓣手术以减轻慢性眼痛。
穿透性角膜移植术后，应定期提醒患者移植伤口易因高风险活动和暴力而受伤。建议角膜移植受者持续佩戴防护眼镜。
