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Graft Rejection Episodes after Descemet’s Stripping with Endothelial Keratoplasty: Part One: Clinical Signs and Symptoms
  1. Christopher S Jordan MD (marianneprice{at},
  2. Marianne O Price, PhD (marianneprice{at},
  3. Rafael Trespalacios MD (marianneprice{at},
  4. Francis W Price, Jr., MD (francisprice{at}
  1. Northeastern Eye Institute, Scranton, PA, United States
  2. Cornea Research Foundation of America, Indianapolis, IN, United States
  3. Brevard Eye Center, Melbourne, FL, United States
  4. Price Vision Group, Indianapolis, IN, United States


    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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