Pahor D
Department of Ophthalmology, University Clinical Centre Maribor, Faculty of Medicine, University of Maribor, Slovenia.
Klin Monbl Augenheilkd. 2013 Aug;230(8):808-13. doi: 10.1055/s-0032-1328637. Epub 2013 Aug 19.
After penetrating keratoplasty (PK) patients remain at risk for wound dehiscence at the graft-host junction even years after surgery. The aim of our study was, firstly, to assess the site-specific characteristics between traumatic and spontaneous wound dehiscence at the graft-host junction and, secondly, to determine the incidence of traumatic and spontaneous wound dehiscence.
The medical records of all 243 patients who underwent a penetrating keratoplasty from 1 March 1996 to 1 March 2012 were retrospectively reviewed. During a 16-year period 9 eyes showed signs of open wound dehiscence after blunt ocular trauma and 7 eyes spontaneously after suture removal.
Over the 16-year period, the incidence of traumatic wound dehiscence was 3.7 % (9 of patients), whereas the incidence of spontaneous wound dehiscence after suture removal was 2.9 % (7 of 243 patients). In traumatic cases the graft dehiscence occurred in 88.9 % (8 of 9 patients) in the nasal part, predominantly in the inferior nasal part. In one case (11.1 %), only the temporal part was affected. The average extent of wound dehiscence for traumatic cases was 96° of the total wound circumference in the nasal part, and only 30° of the circumference in the temporal part. Spontaneous dehiscence after suture removal mainly occurred at temporal site in 71.4 % (5 of 7 eyes), mostly temporal inferior. Only in one case was the nasal part affected (14.3 %). The average extent of wound dehiscence in spontaneous cases was 54° of the total circumference in the temporal part and 21° in the nasal part. The total average extent of dehiscence was significantly larger in traumatic cases, 126° (one third) for traumatic and 75° (one fifth) of the wound circumference for spontaneous cases. All of the re-sutured grafts retained clarity, except for 3 eyes among the traumatic cases.
The difference between both groups was significant regarding the localisation, the extent and the clarity of the re-sutured grafts. The nasal inferior part was the most affected area in traumatic cases probably as a result of indirect, contrecoup injuries, and the temporal part in spontaneous wound dehiscence probably due to direct minor forces.
穿透性角膜移植术（PK）后，患者即使在术后数年仍有移植片-宿主界面伤口裂开的风险。本研究的目的，首先是评估移植片-宿主界面外伤性和自发性伤口裂开的部位特异性特征，其次是确定外伤性和自发性伤口裂开的发生率。
回顾性分析1996年3月1日至2012年3月1日期间接受穿透性角膜移植术的243例患者的病历。在16年期间，9只眼在钝性眼外伤后出现开放性伤口裂开迹象，7只眼在拆线后自发出现。
在这16年期间，外伤性伤口裂开的发生率为3.7%（243例患者中的9例），而拆线后自发性伤口裂开的发生率为2.9%（243例患者中的7例）。在外伤性病例中，88.9%（9例中的8例）的移植片裂开发生在鼻侧部分，主要在鼻下部分。1例（11.1%）仅颞侧部分受累。外伤性病例伤口裂开的平均范围为鼻侧总伤口周长的96°，颞侧仅为30°。拆线后自发性裂开主要发生在颞侧，占71.4%（7只眼中的5只），大多在颞下。仅1例鼻侧部分受累（14.3%）。自发性病例伤口裂开的平均范围为颞侧总周长的54°，鼻侧为21°。外伤性病例裂开的总平均范围明显更大，外伤性为126°（三分之一），自发性为伤口周长的75°（五分之一）。除外伤性病例中的3只眼外，所有重新缝合的移植片均保持透明。
两组在重新缝合的移植片的定位、范围和透明度方面差异显著。外伤性病例中鼻下部分是受影响最严重的区域，可能是间接对冲伤的结果，而自发性伤口裂开中颞侧部分可能是由于直接的轻微外力。
