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Prompt recognition of stromal rejection after DALK may prevent graft failure
Early diagnosis and treatment of stromal rejection in deep anterior lamellar keratoplasty enabled good anatomic and visual outcomes, according to a study.
“The incidence of stromal rejection in DALK is clinically significant, suggesting that these patients may benefit from corticosteroid regimens similar to those used in penetrating keratoplasty and implies that stromal rejection may be more common in penetrating keratoplasty than previously reported,” the study authors said. “If misdiagnosed or left untreated, stromal rejection can compromise graft clarity, but prompt recognition and aggressive treatment can result in good anatomic and visual outcomes.”
The retrospective analysis included clinical records of 20 patients who underwent deep anterior lamellar keratoplasty (DALK) performed by two surgeons.
Five patients (25%) experienced stromal rejection within 12 months. The incidence of stromal rejection after DALK reported in previous studies ranged from 2% to 12%, the authors said.
Stromal rejection was treated aggressively with prednisolone acetate in four of the five patients and less aggressively in the fifth patient, whose rejection was deemed to be more moderate. All episodes of stromal rejection resolved completely with treatment.
“Recognition of the early nonspecific and subacute symptoms of stromal rejection such as mild light sensitivity and eye irritation, as well as clinical signs of sectoral stromal vascularization and infiltrates, often with accompanying edema, is critical in preventing graft failure,” the authors said.