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L. Mosca, R. Fasciani, L. Mosca, L. Guccione, A. Siniscalco, E. Balestrazzi; Stromal Rejection Onset After Femtosecond Laser Assisted Deep Anterior Lamellar Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1124.
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© ARVO (1962-2015); The Authors (2016-present)
To report three cases of stromal rejection in a case series of 19 consecutive eyes submitted to deep anterior lamellar keratoplasty assisted by a femtosecond laser (Femto-DALK).
Three keratoconic eyes of two males aged 18 and 20, and a 24-year-old female undergone to DALK with a 60Khz femtosecond laser (IntraLase, AMO, USA), developed intrastromal graft rejection with superficial and deep neovascularization, after 6 months, 15 months and 18 months, respectively.
In vivo confocal microscopy examination (Confoscan 4, Nidek Technologies, Tokio, Japan) revealed cellular inflammatory infiltrates in the subepithelial and middle stroma of the donor lamella without endothelium involvement. Topical Desamethasone phosphate 0.15% steroid drops were administered 6 times/day for 1 week, then tapered and titrated for 1 month. Two weeks after topical therapy the signs of corneal rejection regressed, showing a clear cornea and restoring of the BSCVA in all cases.
In our case series, only the 6 months case could be time-related to the laser effect. Therefore, despite the mentioned case, our rejection ratio (2 /19: 10.52%) can be compared to the literature data (range: 2.50 to 9.60%).
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