Corneal wound dehiscence after penetrating keratoplasty.

PURPOSE

To describe the clinical features of corneal wound dehiscence after penetrating keratoplasty (PK) after trauma and suture removal.

METHODS

A retrospective review of all eyes needing resuturing in the 5-year period of July 2000 to June 2005 was performed. In total, 76 eyes of 76 patients needed wound resuturing. The indications were early wound leak, wound dehiscence, broken suture, or loose suture. In 29 of the 76 cases, the indication for resuturing after PK was wound dehiscence. Of these, 19 were caused by trauma, and in 10 eyes, dehiscence shortly followed suture removal.

RESULTS

The interval between original PK and traumatic wound dehiscence caused by trauma ranged from 15 days to 33 years. In 5 eyes, it was >15 years. Nine eyes (47%) with traumatic dehiscence had final visual acuity better than 6/60, whereas 8 eyes (80%) with suture removal dehiscence had final visual acuity better than 6/18. Most of the dehiscence in the traumatic group was located in the inferior 2 quadrants, in contrast to temporally in the postsuture removal group. The time interval between PK and suture removal in the postsuture removal group was 16 +/- 4 months, and 7 (70%) patients had a continuous suture. Post-suture removal dehiscence was more common when corneal edema was the indication for grafting.

CONCLUSIONS

Eyes with traumatic wound dehiscence have worse visual outcome than those with dehiscence after suture removal. Patients should be cautioned about the risks and consequences of wound dehiscence. The suture may be left in place longer in older patients or when corneal edema is the indication for grafting.