Penetrating Keratoplasty and Anterior Segment Reconstruction for Severe Ocular Trauma

The authors reviewed 39 consecutive cases of severe ocular trauma that had undergone penetrating keratoplasty plus anterior segment reconstruction and evaluated visual outcome, graft survival, and secondary complications. Postoperatively, 49% of eyes achieved visual acuity of 20/100 or better compared with 10% before surgery, and 72% improved at least 2 Snellen lines. With a mean follow-up of 23 months, 31 (80%) initial keratoplasties remained clear, and all 4 subsequently re-grafted corneas maintained clarity, for an overall keratoplasty success rate of 90%. Elevated intraocular pressure occurred postoperatively in 18 eyes (46%), and, among these, 10 of 13 eyes (77%) had preoperative glaucoma, whereas 8 of 26 (31%) did not ( P ≤ 0.015). Preoperative anterior synechiae could be anatomically corrected at surgery in 80% of cases (24 of 30 eyes). In 7 cases with persistent synechiae, 6 (86%) were associated with glaucoma ( P ≤ 0.025). Retinal detachment occurred in one case. Thus, despite major trauma and a high prevalence of glaucoma, both the visual restoration and anatomic reconstruction achieved were satisfactory and without severe complications.