DLK may reduce risk of endothelial rejection

While deep lamellar keratoplasty reduces the risk of endothelial rejection, epithelial or stromal rejection can still occur, according to a study.

Stephanie L. Watson, FRANZCO, and colleagues studied seven patients with keratoconus who experienced graft rejection after undergoing deep lamellar keratoplasty (DLK) between 1997 and 2001. The authors compared their results with previously reported case series of DLK for keratoconus over the 1994 to 2001 time frame.

The mean age of the patients was 28 years, and the median follow-up was 40 months after surgery.

The main outcome measures included patients’ clinical records, finding details of surgery, interval to the rejection episode and its treatment, best corrected visual acuity (BCVA) and the presence of risk factors for rejection.

In this study, rejection occurred between 3 and 41 months postoperatively. Four patients were atopic, four had a penetrating keratoplasty in the fellow eye and one had deep stromal vessels in the host cornea, they said. In most cases, epithelial rejection preceded stromal rejection, the authors said.

“Isolated epithelial rejection occurred in one patient and stromal rejection in three cases and there were three cases of mixed stromal and epithelial rejection. Topical steroid therapy led to reversal of rejection in five cases,” the authors said. “Two patients had progressive vascularization with graft failure and poor vision.”

The patients with the progressive graft failure were initially thought to be poorly compliant with the topical steroid treatment regimen. The median final BCVA was 6/9, they said.

The study was published in the April issue of Ophthalmology.