Abstract
Purpose :
We investigated the clinical features of immunologic rejection after deep anterior lamellar keratoplasty (DALK).
Methods :
This study included 411 patients (464 eyes, median age [interquartile range] 55.8 [36.1–69.5] years) who underwent DALK at Tokyo Dental College Ichikawa General Hospital, Chiba, Japan between June 1997 and 2021. All DALK procedures were performed using the layer-by-layer, Melles’ viscodissection, or the big bubble technique. Of 411 patients, 24 patients (24 eyes [5.2%], median age 51.9 [31.6–65.4] years) developed immunologic rejection. We investigated clinical features, factors associated with immunologic rejection, and prognosis in 19 patients whose detailed medical records were available.
Results :
The following etiologies were associated with post-DALK immunologic rejection: corneal dystrophy (seven eyes, 29.2%), corneal scars (five eyes, 20.8%), keratoconus (five eyes, 20.8%), herpetic keratitis (three eyes, 12.5%), corneal infection-induced scar (two eyes, 8.3%), and repeat DALK (two eyes, 8.3%). The median interval between surgery and immunologic rejection was 14 (range; 7–20) months. Immunologic rejection occurred after cessation/reduction of topical steroid in 8 (53.3%), after suture removal in 4 (26.7%), after corneal infection in 3 (20.0%), and after intraocular surgery in 1 eye (6.7%). Immunologic stromal rejection manifested as stromal edema in 19 (100.0%), ciliary hyperemia in 17 (89.5%), keratic precipitates in 13 (68.4%), epithelial edema in 13 (68.4%), infiltration in 9 (47.4%), corneal opacity in 4 (21.1%), and double chamber formation in 2 eyes (10.5%). Treatment for immunological rejection included administration of steroid eye drops (19 eyes) and systemic steroid (6 eyes). Corneal clarity was restored in 17 eyes (89.5%); however, rejection led to corneal endothelial decompensation in 2 eyes (10.5%)
We observed reduced post-rejection endothelial cell density (ECD, pre-rejection [1795.7 ± 722.6 cells/mm2] vs. post-rejection [1651.6 ± 655.6 cells/mm2], mean ± standard deviation , p = 0.0735).
Conclusions :
Post-DALK immunologic rejection was associated with specific procedures such as reduction/cessation in administration of steroid eye drops and suture removal. Although patients showed a favorable response to steroid treatment, immunologic stromal rejection may cause ECD loss.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.