Incidence, severity and outcomes of traumatic wound dehiscence following penetrating and deep anterior lamellar keratoplasty

Background Wound dehiscence is an uncommon but significant complication following keratoplasty. This study analysed the incidence, risk factors, clinical features and outcomes of traumatic wound dehiscence following keratoplasty. Methods Retrospective case series at a major tertiary care centre in New Zealand. Records of all consecutive patients who underwent penetrating keratoplasty (PK, n=1163) or deep anterior lamellar keratoplasty (DALK, n=131) between 2000 and 2014 and theatre logs were reviewed to identify all cases of traumatic dehiscence. Main outcome measures include: incidence of traumatic dehiscence, aetiology/associations and final best corrected visual acuity. Results Thirty eyes in 29 patients were identified as having a traumatic wound dehiscence following PK. No cases of wound dehiscence were identified following DALK. The incidence rate of traumatic graft dehiscence among keratoplasties performed at our centre was 2.3 per 1000 person-years. The major causes of trauma were: accidentally being struck by an object (33%) or child (13%), intentional trauma (20%) and falls (13%). Wound rupture occurred at a median of 22 months (range 6 weeks to 32 years) following keratoplasty, most frequently (37%) within the first year. Keratoplasty decompensation occurred in 17 eyes (57%). Final best corrected visual acuity was ≥6/15 in 11 eyes (37%), ≤6/60 in 14 eyes (47%) and no perception of light in 5 eyes (17%). Conclusions Traumatic wound dehiscence may occur following minor trauma, even years after PK and frequently causes severe vision loss. Patients should be advised of this longer term risk and protective eye-wear should be encouraged by eye care providers.