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Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms
  1. C S Jordan1,
  2. M O Price2,
  3. R Trespalacios3,
  4. F W Price, Jr4
  1. 1
    Northeastern Eye Institute, Scranton, Pennsylvania, USA
  2. 2
    Cornea Research Foundation of America, Indianapolis, Indiana, USA
  3. 3
    Brevard Eye Center, Melbourne, Florida, USA
  4. 4
    Price Vision Group, Indianapolis, Indiana, USA
  1. Dr M O Price, Cornea Research Foundation of America, 9002 N. Meridian Street, Ste. 212, Indianapolis, IN 46260, USA; mprice{at}


Aim: To investigate characteristics of initial immunological graft rejection after Descemet stripping with endothelial keratoplasty (DSEK).

Methods: The incidence, symptoms and clinical characteristics of initial immunological graft rejection episodes were analysed retrospectively in 598 eyes treated with primary DSEK at a single tertiary referral centre.

Results: Graft rejection episodes occurred in 54 eyes of 48 patients. Thirty-five per cent of the eyes were asymptomatic and were diagnosed during routine examination. Signs of immunological rejection at the initial diagnosis included keratic precipitates (69%), diffuse corneal oedema (11%) or both (20%); no endothelial rejection lines were observed. In contrast to standard full-thickness grafts, there were no epithelial immunological reactions because the epithelium and anterior stroma are not transplanted in DSEK. Most grafts cleared; four (7%) progressed to graft failure and were successfully regrafted with DSEK.

Conclusions: Immunological graft rejection is an important postoperative complication after DSEK. The range of clinical findings indicative of corneal graft rejection differs in some respects between DSEK and standard penetrating keratoplasty.

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  • Competing interests: FWP receives travel grants from Moria (Antony, France) and is a consultant for Allergan (Irvine, California).

  • Ethics approval: Ethics approval was provided by IRB Company, Buena Park, California.

  • Patient consent: Obtained.