title: Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms.
abstract: OBJECTIVE
  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.
authors.affiliation: Cornea Research Foundation of America, 9002 N. Meridian Street, Ste. 212, Indianapolis, IN 46260, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Jordan
authors.forename: M O
authors.initials: MO
authors.lastname: Price
authors.forename: R
authors.initials: R
authors.lastname: Trespalacios
authors.forename: F W
authors.initials: FW
authors.lastname: Price
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D015715:Corneal Edema / Q000175:diagnosis; D016039:Corneal Transplantation / Q000276:immunology* / Q000379:methods; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000276:immunology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012306:Risk
chemical_list: D000305:Adrenal Cortex Hormones