title: Presumed stromal graft rejection after deep anterior lamellar keratoplasty.
abstract: OBJECTIVE
  To demonstrate the development of presumed immune-mediated stromal rejection after deep anterior lamellar keratoplasty and its reversal after initiation of intensive topical corticosteroid therapy.
  
  
  METHODS
  Observational case report carried out with the approval of the hospital institutional review board.
  
  
  RESULTS
  Stromal edema and peripheral vascularization developed 16 months after deep anterior lamellar keratoplasty for keratoconus in a 13-year-old girl. After 2 weeks of intensive topical corticosteroids, complete reversal of stromal edema and regression of peripheral vascularization occurred, with full recovery of visual function.
  
  
  CONCLUSIONS
  The clinical appearance and response to therapy in this case support the diagnosis of immune-mediated stromal rejection. Ophthalmologists should be aware that sight-threatening stromal rejection may occur in lamellar corneal grafts.
authors.affiliation: Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. atorbaq@health.net.sa
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Torbak
authors.forename: Mohammad
authors.initials: M
authors.lastname: Malak
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Teichmann
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
mesh_terms: D000293:Adolescent; D015715:Corneal Edema / Q000188:drug therapy / Q000209:etiology; D016510:Corneal Neovascularization / Q000188:drug therapy / Q000209:etiology; D003319:Corneal Stroma / Q000187:drug effects / Q000473:pathology*; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone