Cornea Cases

Title:

An endothelial rejection line following Descemet stripping automated endothelial keratoplasty (DSAEK)

Case Report Details

First Author: B.AlQahtani SAUDI ARABIA

Co Author(s):                        

Abstract Details

Purpose:

To present a case with an endothelial rejection line occurring 1 year after DSAEK as a rare presentation of endothelial graft rejection

Setting:

King Abdulaziz University Hospital

Report of case or case series:

A 58-year-old female presented with a one-week history of blurred vision associated with photophobia and redness. The episode started when she tapered her loteprednol from twice a day to once a day. The patient underwent DSAEK regrafting 1 year before her presentation. Her first DSAEK procedure had been performed 4 years prior for a decompensated cornea secondary to an iris-fixated anterior chamber lens. Her best corrected visual acuity in the right eye was 20/200, and the intraocular pressure was 9 mmHg. Slit-lamp examination showed a mildly injected conjunctiva with 1+ corneal oedema (Fig. 1). On the posterior surface of the cornea, there was an endothelial rejection line (Khodadoust line) with KPs extending from 4 to 8 o’clock (Fig. 2). Additionally, there were multiple areas of anterior synechia. The pupil was irregular and oval in shape, and the anterior chamber was deep with occasional cells. Examination of the left eye was unremarkable. The patient had a central corneal thickness of 659 μm (measured by anterior segment optical coherence tomography) on initial presentation (Fig. 3). The diagnosis of graft rejection was made, and the patient was started on prednisolone acetate 1% drops every 1 h. After 1 month of follow-up, the patient’s vision improved from 20/200 to 20/60, and the corneal oedema also improved (Fig. 4)

Conclusions/Take Home Message:

The present case shows that the endothelial rejection line is a rare but important sign of endothelial rejection following DSAEK. Furthermore, the present case raises the possibility that anterior synechia may trigger the formation of Khodadoust lines. Since this is a single case report, it is difficult to explain the underlying mechanism and risk factors associated with the endothelial rejection line following endothelial keratoplasties. Indeed, the classic endothelial rejection line should be kept in mind as a rare sign of DSAEK graft rejection.