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C. S. Jordan, M. O. Price, R. Trespalacios, F. W. Price; Graft Rejection Characteristics in Descemet’s Stripping With Endothelial Keratoplasty (DSEK). Invest. Ophthalmol. Vis. Sci. 2007;48(13):4720.
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To investigate presentation characteristics and patterns of corneal graft rejection in patients who have had Descemet’s stripping with endothelial keratoplasty (DSEK)
This retrospective, interventional case series evaluated patients with previous DSEK procedure performed at a single center who developed immunologic graft rejection. Complaints upon presentation to the clinic as well as objective measurements and findings (visual acuity (VA), presence of keratoprecipitates (KP), corneal edema, and conjunctival injection) were collected and reviewed to help identify common and uncommon presentation patterns of rejection in patients with previous DSEK.
From a chart review of 601 DSEK cases, 477 were seen at our clinic post-operatively at one or more time points between 1 and 30 months. Graft rejection was seen in 26 patients, 4 of which had bilateral rejections that presented at either the same or different times. The mean time from surgery to diagnosis of rejection was 228 days (standard deviation - 141; range 29 - 496) with a median of 231 days. The most common findings where decreased visual acuity, irritation and KP. Of the 30 eyes reviewed: 10 were asymptomatic; 23 had KP; 11 were edematous; 5 had both edema and KP; 16 had documented decreased Va; 14 were irritated; and 8 appeared injected. In contrast to full-thickness grafts there were no epithelial immunologic reactions because the epithelium is not transplant in DSEK. No endothelial rejection lines were observed.
Graft rejection after Descemet’s stripping with endothelial keratoplasty has a wide range of presentation from asymptomatic patients to patients with severely decreased vision, diffuse corneal edema, KP, injection and irritation. Examiners should understand that patients may be rejecting their donor cornea even if they do not show classic rejection patterns on exam or are completely asymptomatic in their history.
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