First report of traumatic scleral rupture after penetrating keratoplasty

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o’clock to 9 o’clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.

Penetran keratoplasti varlýðýnda travmatik skleral rüptür geliþen ilk olgu

Penetran keratoplasti (PK) sonrasý glop rüptürü önemli bir ameliyat sonrasý komplikasyonudur. PK sonrasý kornea yarasý normal kornea dokusunun saðlamlýðýna hiçbir zaman eriþemediðinden, künt travma sonrasýnda glop rüptürü kornea da alýcý-donör yataðýnda gerçekleþir. Biz PK’li hastada künt travmaya baðlý skleral rüptürü geliþen bir hastayý sunduk. Altmýþ yaþýnda kadýn hasta sol gözünde künt travmaya baðlý görme kaybý, kýzarýklýk ve aðrý ile baþvurdu. Ön segment muayenesinde total hifema, yaygýn subkonjonktival hemoraji ve kapaklarda ekimoz mevcuttu. Donör kornea saðlamdý. Sað göz de PK’li, kornea saydam, sklera mavi renkte idi. Limbusa 2 mm mesafede üst kadranda saat 3’ten 9’a kadar uzanan skleral rüptür cerrahi sýrasýnda saptandý. Hastanýn öyküsünde sistemik hipertansiyon dýþýnda baþka bir hastalýðý yoktu. Mavi skleraya neden olan hastalýklarýn ayýrýcý tanýsý yapýldý. Ayrýntýlý öyküde hasta çocukluk döneminde ciddi alerjik göz hastalýðý yaþadýðýný belirtti. Vernal keratokonjonktivite baðlý geliþen komplikasyon tanýsý kondu. PK’li ve mavi skleralý hasta da künt travmaya baðlý kapalý sklera perforasyonu geliþebileceði akýlda bulundurulmalýdýr.