Wound dehiscence after penetrating keratoplasty: Clinical characteristics of 51 cases treated at Bascom Palmer Eye Institute

Purpose: To describe the causes, clinical characteristics, and treatment of wound dehiscence in patients after penetrating keratoplasty (PK).Methods: A retrospective chart review was completed, evaluating patients seen at Bascom Palmer Eye Institute between 1989 and 2001.Results: All dehiscence occurred at the graft-host junction with an average of 5 hours of dehiscence, but no site preference was identified. Dehiscence occurred because of trauma (53%), suturerelated complications (27%), infectious keratitis (8%), and spontaneous wound separation (12%). Twelve patients had either intraocular lens dislocation or expulsion; 42 patients underwent primary repair; 7 patients underwent primary PK; and 1 patient underwent primary evisceration. Surgical details were unavailable for 1 patient. Final visual acuity ranged from 20/20 to no light perception. Acuity was unavailable for 2 patients. Visual acuity was 20/200 or better in 23 patients (47%) and less than 20/200 in 26 patients (53%). Two patients (4%) had no light perception. the visual acuity of 13 patients (27%) was 20/40 or better at their last clinic visit. Comparison of predehiscence and postdehiscence visual acuity showed that 23 eyes (54%) had comparable vision after dehiscence, 11 eyes (25%) had improved vision, and 9 eyes (21%) had worsening of vision.Conclusions: These observations show that graft dehiscence can occur for a variety of reasons after PK, including trauma, infectious keratitis, suture failure, or spontaneous wound separation. the grafthost interface remains vulnerable after corneal transplant and is a potential area for wound dehiscence even many years after keratoplasty. Nevertheless, comparable or even improved vision is possible after wound dehiscence.Michigan State Univ, PLC, Verdier Eye Ctr, Grand Rapids, MI 49546 USAUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc