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Yumiko HIrayama, Akiko Endo, Hiroto Mitamura, Takefumi Yamaguchi, Masatoshi Hirayama, Daisuke Tomida, Seika Den, Yoshiyuki Satake, Jun Shimazaki; Stromal Rejection After Deep Anterior Lamellar Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3209.
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© ARVO (1962-2015); The Authors (2016-present)
Deep anterior lamellar keratoplasty (DALK) has important theoretic safety advantages for corneal disease in patients whose endothelium is not compromised. Endothelial immune graft rejection, which is important postoperative complication for penetrating keratoplasty, cannot occur after DALK. However, corneal stromal edema like graft rejection occurs in some patients after DALK. Here, we investigated the characteristics of the cases of stromal rejection after DALK.
Three hundred and five consecutive series of DALK performed in a single center between June 1997 and April 2013, was retrospectively reviewed. The diagnosis of the stromal rejection was made after the demonstration of acute stromal edema in the absence of confounding preoperative conditions, such as herpetic keratitis. Patients demographics such as background corneal diseases, as well as clinical features including incidence of postoperative stromal rejection, duration until the rejection development, changes in visual acuity, endothelial cell density, and a response for therapy was investigated.
Six of 305 eligible patients experienced stromal rejection. They were 3 males and 3 females, with average of 62 ± 20 years old. The background diseases include 1 lattice dystrophy, 1 keratoconus and 4 corneal opacities. There was no significant difference in preoperative corneal status including endothelial cell density between the patients with and without stromal rejection. Major complications during surgical procedures were not found. Two patients experienced double chamber in early postoperative terms, however, they were recovered completely by air injections. Five of the patients experienced rejection within 1 year, and 1 patient developed 5 years after DALK. All patients were treated with frequent betamethasone sodium phosphate 0.1% eye drops. After the treatment, corneal stromal edema improved promptly, and permanent decreases in visual acuity and endothelial cell density after rejection was not observed.
Our study revealed that stromal graft rejection after DALK was rare but one of the significant complications. The complication can be treated without significant consequences with appropriate therapy.
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