Purpose: To investigate characteristics of initial immunologic graft rejection after Descemet’s stripping with endothelial keratoplasty (DSEK).
Methods: The incidence, symptoms and clinical characteristics of initial immunologic graft rejection episodes were analyzed retrospectively in 598 eyes treated with primary DSEK at a single tertiary referral center.
Results: Graft rejection episodes occurred in 54 eyes of 48 patients. Thirty-five percent of the eyes were asymptomatic and were diagnosed during routine examination. Signs of immunologic rejection at the initial diagnosis included keratic precipitates (69%), diffuse corneal edema (11%), or both (20%); no endothelial rejection lines were observed. In contrast to standard full-thickness grafts, there were no epithelial immunologic reactions because the epithelium and anterior stroma are not transplanted in DSEK. Most grafts cleared; 4 (7%) progressed to graft failure and were successfully regrafted with DSEK.
Conclusions: Immunologic graft rejection is an important post-operative complication after DSEK. The range of clinical findings indicative of corneal graft rejection differs in some respects between DSEK and standard PK.
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