Wound or suture insufficiency complicating penetrating keratoplasty

Background:With regard to penetrating keratoplasty methods to culture corne al donor tissues, microsurgical techniques, HLA typing and understanding of basic mechanisms in inflammation and especially graft rejection,and postop erative treatment schedules have been improved in recent years. This now en ables successful penetrating keratoplasty in many more patients than previo usly performed. However, in rare cases relevant problems in wound closure m ay appear. Patients and methods:A standardized treatment protocol was applied to 1,253 penetrating keratoplasties performed in a single center. Patients were con tinously followed up. Simple leakage after corneal grafting was not further analyzed if conservative treatment or additional sutures achieved sufficie nt wound closure. In 21 cases, however, the causes of large wound dehiscenc e after corneal grafting were analyzed. Results: During the first week early problems in suturing penetrating kerat oplasty in five patients were associated with the instability of the recipi ents' cornea I stroma (stromal thinning in keratoconus or corneal herpes, s uture problems in keratomalacia,active herpes keratitis, corneal burns, or rheumatic diseases). Long-term complications in 16 patients were associated with alcoholism, herpes keratitis, rheumatic disorders or traumatic suture defects. Overall, nine patients lost functionally or even anatomically one eye because of wound dehiscence after corneal grafting. Conclusions: When penetrating keratoplasty is indicated,special attention s hould be given to (1) the compliance of the patient, (2) sufficient treatme nt of herpes keratitis or other infections, (3) adequate immunosuppression in autoimmune corneal inflammation,(4) double running continuous sutures as primary suture with sometimes additonal single sutures to stabilize the gr aft, and (5) surgery in time.