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S.L. Watson, S. Tuft, J.K. Dart; Rejection Following Deep Lamellar Keratoplasty (DLK) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4683.
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Purpose The aim of this study was to evaluate the risk factors & features of graft rejection following DLK. Methods A database of patients undergoing DLK for keratoconus with at least 6 months follow-up was used to identify 6 cases of rejection. This retrospectively recorded data was updated from the clinical case notes. Risk factors associated with rejection in PK were identified from review of the literature. These risk factors were looked for in the patients who had experienced rejection & compared to a group of 24 similar patients, identified from the database, who had not experienced rejection. Further, the clinical signs & symptoms of rejection in these patients were reviewed & compared to published accounts of stromal &/or epithelial graft rejection. Results The patients who had at least one episode of rejection had an average age of 25 years (average follow-up 26 months). The average age of the comparison group was 32 years (average follow-up 33 months). The distribution of risk factors in the 2 groups is shown in the table below. * No significant difference at 5% (Fisher's exact test) The average time to rejection was 10 months (range 3 to 24 months). Epithelial oedema preceded stromal rejection in most cases. Subepithelial infiltrates were seen in one case. Intensive topical steroids lead to resolution of rejection in 4 of the 6 cases. Progression with deep graft vascularisation & stromal opacity occurred in the other 2 patients, their final BCVA's were 6/24 & 6/60 respectively. Conclusions Recently due to advances in surgical technique DLK has been suggested as an alternative to PK when the endothelium is healthy. To date, no cases of rejection have been reported in published series of DLK. Our case series demonstrates that graft rejection is still an issue after DLK & that it maybe severe & irreversible; 2 of our cases progressed with deep graft vascularisation & compromised vision. Further, atopy maybe a risk factor for rejection after DLK such that close monitoring & appropriate steroid therapy are still needed post-operatively, particularly in high-risk patients such as atopes. Larger prospective studies however are needed to establish with certainty the risk factors for rejection after DLK. View OriginalDownload SlideView OriginalDownload Slide
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