Wound dehiscence after penetrating keratoplasty

BACKGROUND: The purpose of this study was to investigate factors affecting wound dehiscence due to blunt trauma following penetrating keratoplasty (PK) and the clinical outcomes.
METHODS: The medical records of patients who experienced blunt traumatic wound dehiscence after PK between 1995 and 2015 were analyzed retrospectively. The incidence and etiology of the trauma, the time interval between PK and globe rupture, final graft clarity, best-corrected visual acuity, complications, secondary surgeries, and factors potentially affecting wound dehiscence size were recorded.
RESULTS: This study included a total of 39 patients with a mean age of 42.66±16.66 years, of whom 23 patients were male and 16 patients were female. The incidence of wound dehiscence was 2.3%. The mean interval between the PK procedure and wound dehiscence was 25.91±47.24 months and the mean follow-up time was 34.43±51.02 months. The most common trauma mechanism was force with a blunt object (53.8%) and the most frequent site of wound dehiscence was the temporal quadrant (30.8%), the wound ranging from 30° to 270° in size. The patients were divided into 4 groups according to wound dehiscence size. As the size of the wound dehiscence size increased, the male ratio increased, wound dehiscence was more commonly located in the nasal and superior quadrants, lens injury and posterior segment complications were more frequent, and graft transparency was achieved at a lower rate.
CONCLUSION: Traumatic wound dehiscence after PK is rare, but may lead to serious, lifelong consequences, including eye loss. Patients should be well informed about the risks and potential sequelae of wound dehiscence.

Penetran Keratoplasti Sonrasý Travmatik Yara Yeri Ayrýlmasý

Amaç: Çalýþmamýzda, penetran keratoplasti (PK) sonrasý künt travmaya baðlý yara açýlmasýný etkileyen faktörleri ve klinik sonuçlarý araþtýrmak amaçlanmýþtýr.
Yöntem: 1995-2015 arasýnda PK sonrasý künt travmaya baðlý yara açmasý geliþen olgular retrospektif olarak tarandý. Travma insidansý ve etiyolojisi, keratoplasti ve glob rüptürü arasýndaki zaman, greft durumu, en iyi düzeltilmiþ görme keskinliði (EDGK), komplikasyonlar, ikincil ameliyatlar ve yaralanma boyutunu etkileyebilecek faktörler kaydedildi.
Bulgular: Çalýþmaya yaþ ortalamasý 42.66 ± 16.66 yýl olan, 23'ü erkek, 16'sý kadýn, toplam 39 hasta dahil edildi. Yara yeri açýlma insidansý % 2.3 idi. Penetran keratoplasti ve travmatik yara yeri açýlmasý arasýndaki ortalama süre 25.91 ± 47.24 ay, ortalama takip süresi 34.43 ± 51.02 ay idi. En yaygýn travma mekanizmasýnýn künt bir nesnenin çarpmasý (% 53.8), en sýk yara yeri ayrýlmasýnýn görüldüðü kadranýn temporal (% 30.8) idi ve yara yeri ayrýlma büyüklüðünün 45° ile 270° arasýnda olduðu saptandý.
Hastalar yara yeri ayrýlma büyüklüðüne göre dört gruba ayrýldý; yara yeri ayrýlma büyüklüðü arttýkça, erkek cinsiyete daha sýk rastlandýðý, nazal ve üst kadranlarda yara yeri ayrýlmasýnýn daha sýk görüldüðü, lens hasarýnýn, arka segment komplikasyonlarýnýn daha sýk ve greft þeffaflýðýnýn daha düþük oranda saðlandýðý izlendi.
Sonuç: Penetran keratoplasti sonrasý ortaya çýkan travmatik yara yeri ayrýlmasý nadir görülen ancak ömür boyu karþýlaþýlabilecek bir komplikasyondur. Göz kaybý gibi ciddi sonuçlar doðurduðundan, hastalar yara yeri ayrýlma riskleri ve sekelleri açýsýndan bilgilendirilmelidir.