Abou-Jaoude Edward S, Brooks Moya, Katz Douglas G, Van Meter Woodford S
Department of Ophthalmology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, USA.
Ophthalmology. 2002 Jul;109(7):1291-6; discussion 1297. doi: 10.1016/s0161-6420(02)01078-3.
To determine the incidence and complications of spontaneous wound dehiscence after removal of a single continuous penetrating keratoplasty (PK) suture.
Retrospective consecutive, noncomparative interventional case series.
Retrospective review of 324 consecutive continuous suture PKs performed between 1992 and 1999.
Sixty-nine (21.3%) of 324 PKs reviewed had the continuous suture removed. The average interval for suture removal after PK was 24.5 +/- 15 months (range, 2.8-63.3 months). Five of the 69 eyes (7.2%) developed spontaneous wound dehiscence without direct eye trauma. In the five eyes that developed wound dehiscence, the continuous suture was removed at 24.6 +/- 10.3 months (range, 14-42 months). Dehiscence occurred at 11.6 +/- 6.5 (range, 3-18) days after suture removal. Significant history associated with wound dehiscence included coughing, yawning, falling without trauma to the eye, and spontaneous wound separation. The reasons for suture removal were astigmatism in four of five (80%) patients and a broken suture in one of the five patients. In four of five (80%) patients, the location of wound dehiscence correlated with the steep axis of corneal keratometry before suture removal. Surgical intervention preserved the presuture removal best-corrected visual acuity in four of the five eyes. No eyes with an intact suture spontaneously dehisced.
The rate of spontaneous wound dehiscence after removal of a continuous suture in our series was 7.2%. All spontaneous dehiscences occurred within 2 weeks after suture removal. Older patients, who had PK for corneal edema with postoperative astigmatism and have been using corticosteroids drops for prolonged periods of time, are at higher risk of wound dehiscence. Patients should be monitored closely during the first 2 weeks after removal of a continuous suture for signs of wound separation, especially when suture removal is performed for astigmatism. Patients should be cautioned about the risk and symptoms of wound dehiscence before suture removal to facilitate early recognition and intervention for preservation of best visual potential.
确定拆除单根连续穿透性角膜移植术（PK）缝线后自发性伤口裂开的发生率及并发症。
回顾性连续非对照干预性病例系列研究。
回顾性分析1992年至1999年间连续进行的324例连续缝线PK手术。
在324例接受回顾的PK手术中，69例（21.3%）拆除了连续缝线。PK术后拆除缝线的平均间隔时间为24.5±15个月（范围2.8 - 63.3个月）。69只眼中有5只（7.2%）在无直接眼部外伤的情况下发生了自发性伤口裂开。在发生伤口裂开的5只眼中，连续缝线在24.6±10.3个月（范围14 - 42个月）时被拆除。伤口裂开发生在拆除缝线后11.6±6.5天（范围3 - 18天）。与伤口裂开相关的重要病史包括咳嗽、打哈欠、无眼部外伤的摔倒以及自发性伤口分离。拆除缝线的原因在5例患者中有4例（80%）是散光，1例是缝线断裂。在5例患者中有4例（80%），伤口裂开的位置与拆除缝线前角膜曲率计的陡峭轴相关。手术干预使5只眼中的4只在拆除缝线前保持了最佳矫正视力。没有完整缝线的眼睛发生自发性裂开。
在我们的系列研究中，拆除连续缝线后自发性伤口裂开的发生率为7.2%。所有自发性裂开均发生在拆除缝线后的2周内。年龄较大、因角膜水肿接受PK且术后有散光并长期使用皮质类固醇滴眼液的患者，伤口裂开的风险较高。在拆除连续缝线后的前2周应密切监测患者是否有伤口分离的迹象，特别是当因散光而拆除缝线时。在拆除缝线前应告知患者伤口裂开的风险和症状，以便早期识别并进行干预，以保留最佳视力潜能。
