OBJECTIVE: To analyze risk factors of traumatic wound rupture after penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). DESIGN: Retrospective case series. PARTICIPANTS: A total of 1962 consecutive cases were included. METHODS: A review of consecutive patients undergoing either PKP (1776 eyes) or DALK (186 eyes) at 1 regional center between 1998 and 2006 was carried out to determine the incidence of traumatic globe rupture after keratoplasty. Ophthalmic and demographic factors were analyzed. A comparison with previous literature was performed. MAIN OUTCOME AND MEASURES: Incidence, causes, and final visual acuity. RESULTS: Of 43 eyes with globe rupture during this period, 36 received keratoplasty during this study period. The incidence of globe rupture after keratoplasty was 1.8% (36/1962). These 36 cases consisted of 35 of the 1776 eyes receiving PKP (2.0%) and 1 of the 186 eyes receiving DALK (0.5%). Globe rupture occurred 61.6+/-50.0 months (mean +/- standard deviation) after keratoplasty in 43 cases. The major cause of trauma was a fall in elderly patients (73.2+/-8.4 years, 17 eyes), with lens damage occurring in all such cases. Although 15 eyes (34.9%) had a visual acuity of 20/200 or better at final follow-up, eyes showing lens damage were associated with poorer visual acuity than eyes with no lens damage (P<0.01). CONCLUSIONS: Wound weakness persisted for a long period after keratoplasty. A fall was observed frequently in elderly patients and resulted in poor visual outcome. Globe rupture associated with lens injury could be the predictor for future visual outcome.
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