SUTURE INSUFFICIENCY COMPLICATING PENETRATING KERATOPLASTY
B. Nölle, G. Grütters, M.A. Halene
Background: Methods to culture corneal donor tissues, microsurgical techniques, HLA-typing and immunology, and postoperative treatment schedules have been improved during the last years. This enables penetrating keratoplasty in much more patients than previously performed. However, in rare cases relevant problems in wound closure may appear.
Patients and Methods: During the last seven years 1000 penetrating keratoplasties have been performed and were continously followed-up with a standardized treatment protocol in a single center. Simple leakage was not further analyzed, if conservative treatment or additional sutures achieved a perfect wound closure. In 21 cases, however, causes for large wound dehiscence after corneal grafting were analyzed.
Results: During the first three days early problems in suturing penetrating keratoplasty in 8 patients were associated with instability of recipients corneal stroma (stromal thinning in keratoconus or corneal herpes, suture problems in keratomalacia, active herpes keratitis, corneal burns, or rheumatic diseases). Long term complications in 13 patients were associated with alcoholism, herpes keratitis,rheumatic disorders or traumatic suture defects.
Conclusions: When penetrating keratoplasty is indicated special attention should be given to (1.) the compliance of the patient, (2.) sufficient treatment of herpes keratitis, (3.) immunosuppression in autoimmune corneal inflammation, (4.) extensive sutures to stabilize the graft.
Clinic for Ophthalmology, Hegewischstr. 2, D-24105 Kiel, F.R.G.