Endophthalmitis and wound dehiscence following late removal of penetrating keratoplasty sutures

■ BACKGROUND AND OBJECTIVE: The patient characteristics, risk factors, and outcome of penetrating keratoplasty (PK) wound dehiscence following late suture removal. ■ PATIENTS AND METHODS: Retrospective review of 207 cases of PK performed between 2005 and 2007 in Beilinson Hospital, Israel. ■ RESULTS: Analysis of 207 patients who underwent PK revealed 4 cases (an incidence of 1.93%) that developed spontaneous wound dehiscence with severe endophthalmitis following late suture removal. Mean time from transplantation to suture removal was 22.18 months (range: 18 to 26 months). The time from suture removal to endophthalmitis was on average 2.25 weeks. All patients underwent vitrectomy with injection of intraocular antibiotics. The causative microorganism was found to be Streptococcus species in three patients and Staphylococcus epidermidis in one patient. One patient retained a clear corneal graft, another patient is scheduled for repeat PK, and the last two patients lost sight (50%). ■ CONCLUSION: Endophthalmitis and wound dehiscence following late suture removal after PK are rare complications, but the end result can be devastating to the transplanted eye when they do occur. Careful monitoring and close follow-up can aid in early identification and treatment of such complications and may prevent loss of sight. Newer methods of corneal transplantation, such as Descemet's stripping automated endothelial keratoplasty or Descemet's membrane endothelial keratoplasty, should be considered as a better alternative to PK whenever the case qualifies as such.