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All age groups at long-term risk of traumatic graft dehiscence after PK
Dehiscence in older patients likely due to falls; younger patients are often struck in the eye.
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 Michael A. Williams |
Penetrating keratoplasty poses a long-term risk of traumatic graft dehiscence in patients of all ages, according to a retrospective study. Findings showed strong correlations between age and causes of traumatic graft dehiscence.
Michael A. Williams, BMedSci, MRCOphth, and colleagues set out to determine the incidence of and risk factors for traumatic graft dehiscence after PK. They compared their results with 12 earlier studies.
The current study included 572 patients who underwent PK at one center between 1992 and 2004. One researcher performed all of the surgeries.
The authors found that 15 eyes (2.6%) were treated for traumatic graft dehiscence. Patients who experienced complications ranged in age from 16 to 89 years, he said.
Cause varied by age
In their own data set, the authors identified a bimodal relationship between age and cause of graft dehiscence, Dr. Williams said. In older patients, graft dehiscence was attributed to falls. Among young patients, dehiscence resulted from being struck in the eye intentionally or accidentally.
“When we analyzed studies previously published on complications of PK, we found that the bimodal pattern of causes of traumatic dehiscence with age was echoed,” he said.
Risk factors identified, weighed
Studying their own data and the 12 other studies, the authors identified risk factors for traumatic graft dehiscence, such as relatively non-inflammatory nylon sutures, Dr. Williams said.
Other studies identified graft size as a risk factor.
“Because virtually the same size graft was used in all of our cases, again, we don’t have evidence, really, to discuss the influence of size of graft,” he said.
Some studies identified time from dehiscence to primary surgical repair as a risk factor for poor outcomes.
“All of our cases underwent immediate primary repair,” removing their ability to analyze that risk factor, Dr. Williams said.
Also, other studies suggested that involvement of the posterior segment signified a poor prognosis, he said.
In their study, about nine of 15 cases with posterior segment involvement experienced diminished visual acuity, Dr. Williams said. However, of six cases that did not have posterior segment involvement, five had reduced visual acuity after primary repair and rehabilitation.
“Just because the posterior segment is uninvolved doesn’t mean the outcome will be good,” he said.
The authors saw long intervals between PK and graft dehiscence, Dr. Williams said. The study found dehiscence occurring 18 years after PK. The literature showed a maximum of 19 years.
“After full-thickness corneal graft surgery, one is never really free of the risk of the complication,” he said. “It’s important to emphasize this to people, especially young people.”
“It was interesting that this bimodal distribution was echoed in the wider data,” Dr. Williams said. “I think it’s useful in terms of tailoring one’s advice to the patient in front of you.”
For more information:
- Michael A. Williams, BMedSci, MRCOphth, can be reached at Department of Geriatric Medicine, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, United Kingdom; +44-289-097-2157; e-mail: mikewilliams99@hotmail.com.
Reference:
- Williams MA, Gawley SD, Jackson AJ, Frazer DG. Traumatic graft dehiscence after penetrating keratoplasty. Ophthalmology. 2008;115:276-278.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.