Journal article
Corneal transplantation wound dehiscence after penetrating keratoplasty and deep anterior lamellar keratoplasty
International ophthalmology, Vol.45(1), 373
09/05/2025
DOI: 10.1007/s10792-025-03708-x
PMCID: PMC12413426
PMID: 40911254
Appears in UI Libraries Support Open Access
Abstract
Purpose
To study clinical characteristics and outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) wound dehiscence.
Methods
This retrospective case series assessed PK and DALK recipients with wound dehiscence at a single institution. We evaluated relationships between dehiscence etiologies, transplant indications, ocular/systemic comorbidities, keratoplasty type, and adverse post-dehiscence outcomes, especially graft failure and visual loss.
Results
Wound dehiscence occurred in 97/1019 eyes (90/863 PK [10.4%] vs 7/156 DALK [4.5%]; p = 0.002). Median time to dehiscence was 6.6 months (range = 1 day–39.2 years). Primary causes included trauma (44.1%) and ulceration (36.1%). Leading surgical indications associated with dehiscence were microbial keratitis and corneal ectasia. Ocular surface disease, viral keratitis, glaucoma, diabetes, and smoking history were more prevalent in PK eyes. Graft failure post-dehiscence was more frequent after PK than DALK (61% vs 0%; p = 0.002) and more rapid with herpetic keratitis history (Log-Rank p = 0.02). Microbial keratitis-associated dehiscence was the strongest predictor of graft failure (odds ratio = 3.9, 95% CI 1.2–12.9). All 20 enucleations occurred in the PK group. Pre-dehiscence, PK eyes had worse habitually corrected visual acuity (HCVA; p = 0.008). Post-dehiscence, more PK eyes lost ≥ 2 Snellen lines (53.7% vs 14.3%; p = 0.058) and HCVA was worse than 20/200 (55.6% vs 0%; p = 0.005).
Conclusion
Wound dehiscence is a serious keratoplasty complication that may be associated with graft failure and vision loss, especially after PK. Careful selection of transplantation techniques and application of therapeutic strategies tailored for the specific surgical indication and associated comorbidities should be used to mitigate the clinical course.
Details
- Title: Subtitle
- Corneal transplantation wound dehiscence after penetrating keratoplasty and deep anterior lamellar keratoplasty
- Creators
- Simran R. Sarin - University of IowaMark A. Greiner - University of IowaGregory A. SchmidtKanwal S. Matharu - University of IowaKenneth M. Goins - University of IowaAnna S. Kitzmann - Gundersen Health SystemJennifer Ling - Costal Surgical CenterMichael D. Wagoner - University of IowaChristopher S. Sales - University of IowaJoanna I. M. Silverman - University of Iowa
- Resource Type
- Journal article
- Publication Details
- International ophthalmology, Vol.45(1), 373
- DOI
- 10.1007/s10792-025-03708-x
- PMID
- 40911254
- PMCID
- PMC12413426
- NLM abbreviation
- Int Ophthalmol
- ISSN
- 0165-5701
- eISSN
- 1573-2630
- Publisher
- Springer Nature
- Language
- English
- Date published
- 09/05/2025
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Pharmaceutical Sciences and Experimental Therapeutics; Internal Medicine; Ophthalmology and Visual Sciences
- Record Identifier
- 9984958295802771
Metrics
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