Late traumatic intraocular lens extrusion after penetrating keratoplasty

Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury.

This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain.

After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.