Traumatic wound dehiscence 3 1/2 years after radial keratotomy [Traumatische Wunddehiszenz und Hornhautruptur 3 1/2 Jahre nach radiarer Keratomie]

Background. Severe complications such as a traumatic wound dehiscence have been described very rarely after radial keratotomy. The following case demonstrates for the first time that wound healing is not completed even 3 1/2 years postoperatively and that therefore an ocular blunt trauma may still case a dehiscence of the radial incisions. Case report. A 22-year-old patient presented in July 1993 to our emergency unit because of a corneal perforation in his right eye after a blunt trauma. His past medical history was significant for radial keratotomy surgery performed in January 1990 to correct a bilateral low-degree myopia (OD=-3.25 D; OS=-3.75 D). At surgery a horizontal rupture running through the entire cornea and including the two radial keratotomies at the 3 and 9 o'clock position was evident. The whole iris and lens were missing. The retina was completely detached. The corneal laceration was sutured. Twelve days later the retina was reattached with an encircling band, vitrectomy, endolaser and cryocagulation, as well as silicone oil fill. Finally, a penetrating keratoplasty was performed 6 months after the accident. Thereafter, visual acuity improved to 0.1. The histological examination of the corneal button showed that the wound healing of the incisions that had remained intact was not completed yet. Epithelial plugs of various size were still filling the somewhat dehiscent wound margins. Fibroblastic activity was detected in the surround stroma. Conclusion. Even several years after surgery, blunt traumas represent a definite risk for eyes undergoing radial keratotomy.