Pahor D, Gracner B, Gracner T
Lehrkrankenhaus Maribor, Augenabteilung, Slowenien.
Klin Monbl Augenheilkd. 2007 Mar;224(3):195-9. doi: 10.1055/s-2007-962954.
Blunt ocular trauma to a corneal transplanted eye represents a higher risk for wound rupture at the donor-recipient interface. We have evaluated the causes, clinical characteristics, treatment and outcome, particularly the graft's clarity, in patients with traumatic wound dehiscence after penetrating keratoplasty.
Between March 1996 and April 2006, over a period of 10 years, 4 patients who had previously undergone successful penetrating keratoplasty and subsequently sustained traumatic wound dehiscence were treated at our department. All eyes underwent primary wound closure with interrupted 10-0 nylon sutures.
Over the 10-year period, the incidence of traumatic wound dehiscence in which penetrating keratoplasty was performed was 2.35 % (4 of 170 patients). The ages of our patients at the time of injury were 6, 76, 78 and 39 years. The interval between penetrating keratoplasty and trauma varied from 12 through 16 and 17 to 30 months. All corneal dehiscences occurred at the graft-host junction. All dehiscences were at the temporal-superior quadrant (4 of 4 eyes) and at superior-nasal and temporal quadrants in 3 of 4 eyes. Two eyes that were pseudophakic had lost their implants and required anterior vitrectomy. In one of these patients (a 76-year-old women) delayed-onset expulsive choroidal haemorrhage occurred at the end of surgical repair. Visual outcome was correlated with the force of trauma, previous eye conditions and complications during surgery. All of the resutured grafts retained clarity.
Traumatic wound dehiscence is a serious and not uncommon complication following penetrating keratoplasty. Despite severe trauma, graft transparency was achieved in all cases and there was no need for regrafting.
钝性眼外伤累及角膜移植眼时，供体 - 受体界面伤口破裂的风险更高。我们评估了穿透性角膜移植术后发生外伤性伤口裂开患者的病因、临床特征、治疗及预后，尤其是植片的透明度。
在1996年3月至2006年4月的10年间，我们科室治疗了4例先前穿透性角膜移植成功但随后发生外伤性伤口裂开的患者。所有患眼均采用10-0尼龙线间断缝合进行一期伤口闭合。
在这10年期间，接受穿透性角膜移植术后发生外伤性伤口裂开的发生率为2.35%（170例患者中的4例）。我们的患者受伤时年龄分别为6岁、76岁、78岁和39岁。穿透性角膜移植术与外伤之间的间隔时间从12个月到16个月、17个月至30个月不等。所有角膜裂开均发生在植片 - 宿主交界处。所有裂开均位于颞上象限（4只眼中的4只），4只眼中有3只同时累及鼻上象限和颞象限。2只人工晶状体眼的人工晶状体已脱位，需要进行前部玻璃体切除术。其中1例患者（一名76岁女性）在手术修复结束时发生了迟发性脉络膜出血。视力预后与外伤力度（原文为force，这里结合语境翻译为力度更合适）、既往眼部情况及手术并发症相关。所有重新缝合的植片均保持透明。
外伤性伤口裂开是穿透性角膜移植术后一种严重且并非罕见的并发症。尽管外伤严重，但所有病例均实现了植片透明，无需再次移植。
