Retrospective consecutive, noncomparative interventional case series.
METHODS: 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.