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Comparative Evaluation Of Clinical Characteristics And Visual Outcomes Of Traumatic And Non-Traumatic Graft Dehiscence Following Corneal Transplantation Surgery

Authors Stevenson LJ, Abell RG, McGuinness MB, Vajpayee RB

Received 17 August 2019

Accepted for publication 14 October 2019

Published 18 November 2019 Volume 2019:13 Pages 2243—2249


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Louis J Stevenson,1 Robin G Abell,1 Myra B McGuinness,2 Rasik B Vajpayee1,3,4

1Royal Victorian Eye and Ear Hospital, Melbourne, Victoria 3002, Australia; 2Centre for Eye Research Australia, Melbourne, Victoria 3002, Australia; 3University of Melbourne, Parkville, Victoria 3010, Australia; 4Vision Eye Institute, Melbourne, Victoria 3004, Australia

Correspondence: Rasik B Vajpayee
Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia

Purpose: To compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.
Methods: Retrospective review of all patients presenting with post-keratoplasty wound dehiscence to the Royal Victorian Eye and Ear Hospital between January 2005 and December 2017. Patients with wound dehiscence following keratoplasty of any cause were included.
Results: Of 71 eyes from 71 patients included, 60 (85%) were penetrating keratoplasty patients. The mean age was 56.4 years (SD=22.7, range 17.6–97) and 62% (n = 44) of patients were male. There were 28 (39%) cases of traumatic dehiscence and 43 (61%) cases of non-traumatic dehiscence. The median time interval from keratoplasty to dehiscence was significantly less in non-traumatic patients than traumatic patients (0.2 years, IQR 0.1–2.0 vs 2.3 years, IQR 0.3–14.8, p=0.01). There was no significant difference in best-corrected visual acuity at 6 months between traumatic and non-traumatic dehiscence (6/60 vs 6/36, p=0.62), suture technique (continuous vs interrupted, p=0.12), or graft type (penetrating keratoplasty vs deep anterior lamellar keratoplasty) after adjusting for keratoconus (p=0.41).
Conclusion: Post-keratoplasty wound dehiscence is a serious complication and can cause significant loss of vision. While the risk of dehiscence is lifelong, the first 3 years post-keratoplasty carry the highest risk, with non-traumatic dehiscence tending to occur earlier than traumatic dehiscence.

Keywords: graft dehiscence, trauma, keratoplasty, cornea

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