Traumatic wound rupture after penetrating keratoplasty in Africa

Aim-To investigate risk factors, visual outcome, and graft survival for tra umatic wound rupture after penetrating keratoplasty. Methods-A retrospective analysis of 336 patients who underwent penetrating keratoplasty from 1988 to 1995. Results-19 patients (5.7%) suffered traumatic postoperative wound rupture r equiring surgical repair. They were younger (mean age 16.6 years, 95% CI 13 .2-20.6) and more frequently keratoconic (p = 0.01) than other patients (me an age 28.9 years, 95% CI 26.-31.0). Mean postoperative follow up was 37.7 (SD 22.9) months and 24.5 (18.9) months for the rupture and non-rupture pat ients. Mean interval between keratoplasty and rupture was 18 (21) weeks. Th e lens was damaged and removed in 37% of ruptured eyes. For keratoconics, t he probability of graft survival at 5 years was lower (p = 0.03) in the rup tured eyes (75%) than in the nonruptured eyes (90%). Endothelial failure wa s a more common (p <0.05) cause of graft opacification in ruptured grafts t han in intact grafts. Of the ruptured eyes, 53% achieved a final corrected acuity of at least 6/18 and 63% achieved at least 6/60 compared with 48% an d 71% of the intact eyes respectively (both p >0.1). The proportion of kera toconic eyes which achieved at least 6/60 was lower (p = 0.02) in the ruptu red eyes (67%) than the non-ruptured eyes (87%). Eyes with wound ruptures o f 5 clock hours or greater were less likely (p <0.05) to achieve an acuity of 6/18 and were more likely (p <0.05) to have an associated lens injury. Conclusions-Graft rupture is relatively common in African practice, particu larly in young keratoconics. Visual outcome and graft survival are not sign ificantly worse than for other grafted eyes, but are significantly worse th an for other grafted keratoconic eyes.