April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Stromal Rejection After Deep Anterior Lamellar Keratoplasty
Author Affiliations & Notes
  • Yumiko HIrayama
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Akiko Endo
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Hiroto Mitamura
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Takefumi Yamaguchi
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Masatoshi Hirayama
    Department of Ophthalmology, Keio university, Tokyo, Japan
  • Daisuke Tomida
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Seika Den
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Yoshiyuki Satake
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
  • Jun Shimazaki
    Ophthalmology, Tokyo Dental Collage Ichikawa General Hospital, Ichikawa, Japan
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 3209. doi:
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    • Get Citation

      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)

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Abstract
 
Purpose
 

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.

 
Methods
 

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.

 
Results
 

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.

 
Conclusions
 

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.

 
Keywords: 479 cornea: clinical science  
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