Penetrating keratoplasty and anterior segment reconstruction for severe ocular trauma

The principles for management of acute ocular trauma are also applicable to the subsequent reconstruction of the anterior segment. As with the primary repair of ocular trauma, meticulous anatomical restoration during reconstructive surgery minimizes secondary complications and enhances the visual prognosis. Anterior segment reconstruction may then involve procedures such as stripping of corneal pannus, removal of lens and vitreous remnants, iris and angle reconstruction, intraocular lens implantation, and penetrating keratoplasty. A total of 39 consecutive cases of severe ocular trauma, which had undergone penetrating keratoplasty and anterior segment reconstruction, were evaluated for visual outcome, graft survival, and secondary complications. Post-operatively, 49% of eyes achieved > 20/100 as compared with 10% before surgery, and 72% improved by at least two Snellen lines. In all, 31 (80%) initial keratoplasties remained clear, as did all 4 subsequently regrafted corneas, for an overall keratoplasty success rate of 90%. Elevated intraocular pressure occurred postoperatively in 18 eyes (46%), and among these, 10 of 13 eyes (77%) had preoperative glaucoma, whereas 8 of 26 (31%) did not (P < 0.015). Peripheral anterior synechiae could be anatomically corrected at surgery in 80% of cases (24 of 30 eyes). Thus, despite major trauma and a high prevalence of glaucoma, both the visual and the anatomical improvements were highly satisfactory and without severe complications.