June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Immunologic rejection after deep anterior lamellar keratoplasty
Author Affiliations & Notes
  • hirotsugu kasamatsu
    ophthalmology, Tokyo Shika Daigaku Ichikawa Sogo Byoin, Ichikawa, Chiba, Japan
    ophthalmology, Shinshu Daigaku, Matsumoto, Nagano, Japan
  • Takefumi Yamaguchi
    ophthalmology, Tokyo Shika Daigaku Ichikawa Sogo Byoin, Ichikawa, Chiba, Japan
  • Daisuke Tomida
    ophthalmology, Tokyo Shika Daigaku Ichikawa Sogo Byoin, Ichikawa, Chiba, Japan
  • Sota Nishisako
    Cornea Center and Eye bank, Tokyo Shika Daigaku Ichikawa Sogo Byoin, Ichikawa, Chiba, Japan
  • Jun Shimazaki
    ophthalmology, Tokyo Shika Daigaku Ichikawa Sogo Byoin, Ichikawa, Chiba, Japan
  • Footnotes
    Commercial Relationships   hirotsugu kasamatsu None; Takefumi Yamaguchi Alcon, Code R (Recipient), Johnson, Code R (Recipient), Otsuka, Code R (Recipient), Santen, Code R (Recipient), Senju, Code R (Recipient); Daisuke Tomida None; Sota Nishisako None; Jun Shimazaki Alcon, Code R (Recipient), Otsuka, Code R (Recipient), Santen, Code R (Recipient), Senju, Code R (Recipient)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5107. doi:
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      hirotsugu kasamatsu, Takefumi Yamaguchi, Daisuke Tomida, Sota Nishisako, Jun Shimazaki; Immunologic rejection after deep anterior lamellar keratoplasty. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5107.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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