J Korean Ophthalmol Soc.  2011 Mar;52(3):359-363. 10.3341/jkos.2011.52.3.359.

Delayed-Onset Expulsive Suprachoroidal Hemorrhage Due to a Trauma after Removal of Penetrating Keratoplasty Suture

• Choi YJ
• Jung MS

• KMID: 2214303
• DOI: http://doi.org/10.3341/jkos.2011.52.3.359

Abstract

PURPOSE
To report a case of delayed-onset expulsive suprachoroidal hemorrhage due to trauma after removal of a penetrating keratoplasty suture.
CASE SUMMARY
A 66-year-old man had penetrating keratoplasty for bullous keratopathy performed in his left eye. After 1 year, the continuous suture was removed for adjustment of astigmatism. Four days after removal of the suture, the patient struck his left eye with the back of his hand, although at the time of injury he had no specific symptoms. Two days later, the patient noticed abrupt pain, decreased visual acuity, and massive hemorrhage in his left eye. Examination revealed an inferior wound dehiscence of approximately 8 clock hours (2 thru 10 o'clock) with prolapsed intraocular contents such as the uvea and retina. The patient underwent cornea graft resuturing with resection of ocular contents, which could not be repositioned. Although bleeding was controlled after the operation, vision was lost in his left eye. After two months, according to decrement of intraocular hematoma, the patient had a phthisis bulbi with low intraocular pressure in his left eye.
CONCLUSIONS
Persistent low intraocular pressure due to wound leakage through the graft-host junction likely resulted in delayed onset of expulsive suprachoroidal hemorrhage. The risk of traumatic corneal graft rupture after penetrating keratoplasty is significant and is associated with a poor visual outcome and eyeball viability. Therefore, patients should be cautioned. In addition, the importance of eye examination after trauma should be emphasized.

Keyword

Penetrating keratoplasty; Suprachoroidal hemorrhage; Trauma; Wound dehiscence

MeSH Terms

Aged
Astigmatism
Cornea
Eye
Hand
Hematoma
Hemorrhage
Humans
Intraocular Pressure
Keratoplasty, Penetrating
Retina
Rupture
Sutures
Transplants
Uvea
Vision, Ocular
Visual Acuity

Figure

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  Figure 1. One year after penetrating keratoplasty.

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  Figure 2. Two days after trauma. (A) Patient reveals massive hemorrhage with intraocular contents protruded through extensive corneal wound dehiscence. (B) Operator's view. Hinged corneal graft-host junction dehiscence is found from 2 to 10 o'clock site. Black arrows indicate protruding retinal and uveal tissues.

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  Figure 3. Ultrasound image and anterior segment photograph at postoperative one week.

Reference

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