Presumed stromal graft rejection after deep anterior lamellar keratoplasty.
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.
Al-Torbak
Abdullah
A
Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. atorbaq@health.net.sa
Malak
Mohammad
M
Teichmann
Klaus D
KD
Wagoner
Michael D
MD
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
D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone