Late stromal rejection in deep anterior lamellar keratoplasty: a case series

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 10:18

Venue: Hall C1

First Author: : N.Maycock UK

Co Author(s): :    A. Garg   H. Roberts   D. O'Brart              

Abstract Details

Purpose:

To report a series of 4 cases (3 patients) with late stromal graft rejection 32-46 months after surgically uncomplicated deep anterior lamellar keratoplasty (DALK). To our knowledge there are no reported cases series in the scientific literature of isolated stromal rejection after DALK at such a late stage.

Setting:

Department of Ophthalmology, St Thomas Hospital, Guys & St Thomas NHS Foundation Trust, Lambeth Palace Road, London, SE1 7EH

Methods:

Retrospective case series study. Four cases of stromal graft rejection (6%) in 3 patients occurring more than 24 months after uncomplicated DALK were identified from a series of 61 consecutive eyes of 56 patients who underwent DALK at our institution between 2006 and 2012. The case details were obtained from review of the clinical case notes. Patient demographics and risk factors associated with rejection after PK were identified, including atopy, previous grafts in the operated or contra lateral eye, host vascularisation, ocular surface disorders and raised intraocular pressure. The clinical signs and symptoms of rejection in these cases were recorded.

Results:

All eyes responded well to treatment, becoming more comfortable, with decreasing redness, reversal of corneal oedema and return of pre-rejection best spectacle corrected visual acuity (BSCVA) with up to 18 months follow-up. The patients continued on a tapering dosage of topical corticosteroid for 8-12 months. In one eye topical steroids were re-introduced at 13 months due to a further rejection episode. Best spectacle corrected distance acuity was equal or greater than 20/30 in all eyes at the last follow up visit.

Conclusions:

These cases of late stromal rejection following DALK provide clinical evidence that donor keratocytes may persist in such lamellar grafts for extended periods of time. This possible persistence of stromal keratocytes is important as it means that stromal graft rejection can potentially occur years and perhaps decades after otherwise uncomplicated DALK surgery. To our knowledge this is the first report of such isolated late stromal graft rejection episodes after DALK. Patients and surgeons alike should be aware of this potential late complication, the presenting symptoms and signs as well as the need to seek prompt ophthalmological attention for this.

Financial Disclosure:

NONE