Ocular trauma following penetrating keratoplasty: incidence, outcome, and postoperative recommendations

The surgical wound after penetrating keratoplasty is more vulnerable to contusive trauma than the intact cornea.

To assess the incidence of ocular trauma following penetrating keratoplasty, and to evaluate its causative factors, management, and visual outcome.

Tertiary referral facility in a fairly closed population.

Retrospective study assessing ocular injuries of all 559 patients who underwent penetrating keratoplasty in the center between September 1986 and March 1993.

Fourteen (2.5%) of 559 patients who underwent penetrating keratoplasty, over a period of 78 months, suffered surgical wound dehiscence because of contusive ocular trauma. The mean age of the patients (30.6 years) was significantly lower (P<.001) than that of the total number of patients who received transplants (49 years). The interval between transplantation and trauma ranged from 2 weeks to 2 years (mean interval, 6.7 months). In 11 of the 14 patients the trauma occurred prior to removal of sutures. Globe rupture occurred at the donor-recipient interface in all of the patients, accompanied by vitreous and lens loss in 8 patients (57%). In 2 patients (14%) trauma included disruption of retinal tissue resulting in poor visual outcome. The trauma occurred most often at home (in 7 patients). After follow-up periods of 1 to 6 years (mean, 29 months), the corrected visual acuity ranged from 20/120 to 20/20 in 12 patients (86%).

Ocular injury following penetrating keratoplasty is not a rare event. Since corneal graft wound is vulnerable to ocular trauma, we recommend the constant use of protective eyewear and periodically instruct the patients on the long-term vulnerability of the graft wound. Patients should be repeatedly cautioned against high-risk environments and strenuous activity.