title: Graft rejection after femtosecond laser--assisted deep anterior lamellar keratoplasty: report of 3 cases.
abstract: OBJECTIVE
  To report 3 cases of stromal rejection after deep anterior lamellar keratoplasty (DALK) assisted by a femtosecond laser.
  
  
  METHODS
  Three keratoconus eyes of 2 men (22 and 30 years old) and 1 woman (24 years old) who had DALK with a 60-kHz femtosecond laser developed intrastromal graft rejection with superficial and deep neovascularization after 6, 15, and 12 months, respectively. All patients underwent confocal microscopy and were treated with topical steroid therapy.
  
  
  RESULTS
  In vivo confocal microscopy revealed cellular inflammatory infiltrates in the subepithelial and middle stroma of the donor lamella without involvement of the endothelium. Graft rejection was rapidly reversed with topical steroid therapy, and a clear cornea was restored in all cases.
  
  
  CONCLUSIONS
  Graft rejection remains a significant complication of lamellar surgery but is associated with good tissue restoration and complete visual recovery.
authors.affiliation: Department of Ophthalmology, Catholic University of Sacro Cuore, A. Gemelli Polyclinic, Rome, Italy. l.mosca@tin.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Mosca
authors.forename: Romina
authors.initials: R
authors.lastname: Fasciani
authors.forename: Luca
authors.initials: L
authors.lastname: Mosca
authors.forename: Laura
authors.initials: L
authors.lastname: Guccione
authors.forename: Emanuela Filomena
authors.initials: EF
authors.lastname: Legrottaglie
authors.forename: Andrea
authors.initials: A
authors.lastname: Siniscalco
authors.forename: Monica
authors.initials: M
authors.lastname: Riso
authors.forename: Emilio
authors.initials: E
authors.lastname: Balestrazzi
mesh_terms: D000328:Adult; D003319:Corneal Stroma / Q000473:pathology; D016039:Corneal Transplantation / Q000009:adverse effects*; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D018613:Microscopy, Confocal; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D003907:Dexamethasone