Spontaneous wound dehiscence after removal of single continuous penetrating keratoplasty suture

PURPOSE: To determine the incidence and complications of spontaneous wound dehiscence after removal of a single continuous penetrating keratoplasty (PK) suture. DESIGN: Retrospective consecutive, noncomparative interventional case series. METHODS: Retrospective review of 324 consecutive continuous suture PKs performed between 1992 and 1999. RESULTS: Sixty-nine (21.3%) of 324 PKs reviewed had the continuous suture removed. The average interval for suture removal after PK was 24.5 +/- 15 months (range, 2.8-63.3 months). Five of the 69 eyes (7.2%) developed spontaneous wound dehiscence without direct eye trauma. In the five eyes that developed wound dehiscence, the continuous suture was removed at 24.6 +/- 10.3 months (range, 14-42 months). Dehiscence occurred at 11.6 +/- 6.5 (range, 3-18) days after suture removal. Significant history associated with wound dehiscence included coughing, yawning, falling without trauma to the eye, and spontaneous wound separation. The reasons for suture removal were astigmatism in four of five (80%) patients and a broken suture in one of the five patients. In four of five (80%) patients, the location of wound dehiscence correlated with the steep axis of corneal keratometry before suture removal. Surgical intervention preserved the presuture removal best-corrected visual acuity in four of the five eyes. No eyes with an intact suture spontaneously dehisced. CONCLUSIONS: The rate of spontaneous wound dehiscence after removal of a continuous suture in our series was 7.2%. All spontaneous dehiscences occurred within 2 weeks after suture removal. Older patients, who had PK for corneal edema with postoperative astigmatism and have been using corticosteroids drops for prolonged periods of time, are at higher risk of wound dehiscence. Patients should be monitored closely during the first 2 weeks after removal of a continuous suture for signs of wound separation, especially when suture removal is performed for astigmatism. Patients should be cautioned about the risk and symptoms of wound dehiscence before suture removal to facilitate early recognition and intervention for preservation of best visual potential.