外伤致穿透性角膜移植伤口裂开八例并文献复习

Traumatic wound dehiscence after penetrating keratoplasty: eight cases and a literature view

目的通过分析穿透性角膜移植术后外伤性伤口裂开的患者特征、危险因素、并发症和视觉结果,提高穿透性角膜移植术后对外伤的重视及防护。方法回顾性分析2014年至2015年收治的8例(8眼)外伤致穿透性角膜移植伤口裂开患者病例资料并同期Pubmed数据库所有类似报道49例49眼病例资料,共57例(57眼)。结果 57例(57眼)外伤时年龄4~72岁,平均(39.86±17.63)岁。穿透性角膜移植术和外伤之间的时间范围0.6个月~34年,平均(23.05±15.99)个月。在眼前段损伤中,晶状体/人工晶体脱出26眼、虹膜脱垂22眼、前房积血19眼。在眼后段损伤中,玻璃体脱出18眼、玻璃体积血17眼、视网膜脱离8眼、脉络膜上腔出血3眼。所有患者中外伤后继发眼内炎、增殖性玻璃体视网膜病变各1例。再次治疗后最佳矫正视力21眼≥0.1,手动<13眼<0.1,15眼手动或者光感,8眼无光感。四肢及不同物体击伤眼部是研究中伤口裂开的最常见原因。结论穿透性角膜移植术后伤口裂开的风险终身存在,无论患者年龄、手术适应证、穿透性角膜移植术后时间,尤其是外伤后更容易发生且伤口裂开时间最可能发生在穿透性角膜移植术后第一年。多数患者有较差的视觉结果,少数无严重眼部并发症且无眼后段损伤者可有良好视觉结果。

Objective To analyze the patient characteristics,risk factors,complications,and visual outcomes of traumatic wound dehiscence after penetrating keratoplasty and to highlight the importance of prevention of trauma after penetrating keratoplasty.Methods We retrospectively reviewed the medical records at our institution from 2014 to 2015 and identified 8 eyes（ 8 patients）who had undergone penetrating keratoplasty followed by traumatic wound dehiscence. A review of the PubMed database identified reports on 49 further eyes（ 49 patients）,giving a total of 57 eyes（ 57 patients）. Results The 57 affected eyes were in patients of mean age 39.86± 17.63 years. The mean duration between the data of penetrating keratoplasty and the trauma was 23.05± 15.99 months. The associated anterior segment injuries included prolapse of the lens/intraocular lens in 26 eyes,prolapse of the iris in 22 eyes,and hyphema in 19 eyes. The associated posterior segment injuries included prolapse of the vitreous in 18 eyes,vitreous hemorrhage in 17 eyes,retinal detachment in 8 eyes,and suprachoroidal hemorrhage in 3 eyes. After traumatic wound dehiscence,1 patient had endophthalmitis and 1 patient developed proliferative vitreoretinopathy. Best-corrected visual acuity was 0.1 or better in 21 eyes,better than hand motion to less than 0.1 in 13 eyes,hand motion or light perception in 15 eyes,and no light perception in 8 eyes after retreatment. Injury of the limbs and different objects was the most common cause of wound dehiscence. Conclusion Patients who undergo penetrating keratoplasty have a life-long risk of wound dehiscence,regardless of age,indication for penetrating keratoplasty,and time since penetrating keratoplasty. Wound dehiscence is more likely to occur after trauma,particularly in the first year after penetrating keratoplasty. Most patients have a poor visual outcome. Absence of serious eye complications and posterior segment injury is associated with a better visual outcome.