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Year : 2007  |  Volume : 55  |  Issue : 1  |  Page : 69-70

Traumatic globe rupture after deep anterior lamellar keratoplasty

1 Department of Ophthalmology, College of Medicine, King Saud University, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
2 Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
3 Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Date of Submission11-Oct-2005
Date of Acceptance07-Sep-2006

Correspondence Address:
Abdullah Al-Torbak
King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh - 11462
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.29502

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We report a case of traumatic globe rupture following blunt trauma in the left eye of a 20-year-old male who had undergone deep anterior lamellar keratoplasty for keratoconus. Extrusion of the crystalline lens and prolapse of vitreous through the inferior 180 donor host junction was noted. After the repositioning of the graft, anterior vitrectomy and repair of graft host junction, the graft regained clarity in eight weeks with good visual recovery.

Keywords: Corneal grafts, deep anterior lamellar keratoplasty, traumatic globe rupture.

How to cite this article:
Kalantan H, Al-Shahwan S, Al-Torbak A. Traumatic globe rupture after deep anterior lamellar keratoplasty. Indian J Ophthalmol 2007;55:69-70

How to cite this URL:
Kalantan H, Al-Shahwan S, Al-Torbak A. Traumatic globe rupture after deep anterior lamellar keratoplasty. Indian J Ophthalmol [serial online] 2007 [cited 2022 Aug 7];55:69-70. Available from: https://www.ijo.in/text.asp?2007/55/1/69/29502

Deep anterior lamellar keratoplasty (DALKP) is a surgical procedure that removes recepient corneal stroma down to the descemet's membrane followed by transplantation of donor cornea after removing the descemet endothelial layer. Although considered safe, some complications after this procedure have been reported. They include intraoperative perforation, interface haze and/or neovascularization and persistent epithelial defects.[1] We report a traumatic globe rupture after DALKP. We could not find similar report on literature search (Medline).

  Case Report Top

A 20-year-old male presented with severe ocular pain and sudden drop in vision in the left eye after a severe blunt trauma by a car door.

He previously had uncomplicated DALKP performed for keratoconus on his both eyes. His medical history was otherwise unremarkable.

Visual acuity (VA) was 20/40 without correction in the right eye, improving to 20/20 with pinhole and hand motion in the left eye. Left eye showed inferior 180 dehiscence in the graft host junction of the lamellar button with vitreous prolapse and lens extrusion. Anterior chamber was flat. Right eye examination was unremarkable.

Anterior vitrectomy and repair of the inferior 180 wound by interrupted 10-0 nylon sutures were performed. Intracameral air injection to tamponade the descemet's membrane was done. Subconjunctival steroid and antibiotic were given at the end of the procedure. Microbiological workup for the vitreous sample was negative and the patient was treated postoperatively with intravenous antibiotics. Topical prednisolone acetate 1.0% and ofloxacin 0.3% were administered four times daily for 10 days. The topical steroids were tapered and discontinued over the next 12 weeks. The graft was hazy initially but gradually cleared over eight weeks (Figs. 1 and 2).

Five months after the surgery, VA in the right eye was 20/30 without correction, improving to 20/20 with pinhole. VA in the left eye was 20/40 with the correction of +9.0 diopter sphere and -2.0 diopter cylinder at 45. Posterior segment and intraocular pressure were within normal limits.

  Discussion Top

Histopathological studies confirm that corneal wounds never regain their original strength.[2],[3] Histopathological changes including incarceration of bowman's or descemet's membrane or retrocorneal fibrous tissue sealing the wound have been observed 25 years after surgery. They have shown that corneal wounds continue to remain weak.[2] Furthermore, postmortem studies of eyes that underwent penetrating keratoplasty (PKP) show incomplete wound healing microscopically, at the graft-donor interface in 86.7% of patients.[3]

Traumatic wound dehiscence after PKP is a significant potential postoperative complication, ranging in incidence from 1-9%.[4],[5],[6] It can occur spontaneously, after suture removal or even after a minor blunt trauma. Elder and Stack[7] observed that the highest risk for wound dehiscence after PKP was in the first month after surgery and the first month after suture removal. They recommended 24h eye protection during these periods. Moreover, they advised eyewear while awake in the first six months after grafting and in the first six months after suture removal as well as permanent avoidance of activities that risk ocular trauma. Unfortunately, our patient was not wearing any eye protection at the time of his trauma.

Although descemet's membrane might be considered a barrier against possible trauma in surgeries that do not compromise it, there have been reports of cases of globe rupture after radial keratotomy[8] and laser in situ keratomileusis.[9]

To our knowledge, this is the first report of globe rupture after blunt trauma in eye that had DALKP. Ophthalmologists should be aware that globe rupture may occur in lamellar corneal grafts.

  References Top

Watson SL, Ramsay A, Dart JK, Bunce C, Craig E. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology 2004;111:1676-82.  Back to cited text no. 1
Flaxel JT, Swan KC. Limbal wound healing after cataract extraction. Arch Ophthalmol 1969;81:653-9.  Back to cited text no. 2
Lang GK, Green WR, Maumenee AE. Clinicopathologic studies of keratoplasty eyes obtained post mortem. Am J Ophthalmol 1986;101:28-40.  Back to cited text no. 3
Agrawal V, Wagh M, Krishnamachary M, Rao GM, Gupta S. Traumatic wound dehiscence after penetrating keratoplasty. Cornea 1995;14:601-3  Back to cited text no. 4
Rohrbach JM, Weidle EG, Steuhl KP, Meilinger S, Pleyer U. Traumatic wound dehiscence after penetrating keratoplasty. Acta Ophthalmol Scan 1996;74:501-5.  Back to cited text no. 5
Bowman RJ, Yorsten D, Aitchison TC, McIntyre B, Kirkness CM. Traumatic wound rupture after penetrating keratoplasy in Africa. Br J Ophthalmol 1999;83:530-4.  Back to cited text no. 6
Elder MJ, Stack RR. Globe rupture following penetrating keratoplasty: How often, why and what can we do to prevent it? Cornea 2004;23:776-80.   Back to cited text no. 7
Rashid P, Waring GO 3rd. Complications of radial and transverse keratotomy. Surv Ophthalmol 1989;34:73-106.  Back to cited text no. 8
Sun CC, Chang SW, Tsai RR. Traumatic corneal perforation with epithelial ingrowth after laser in situ keratomileusis. Arch Ophthalmol 2001;119:907-9.  Back to cited text no. 9


  [Figure - 1], [Figure - 2]

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