title: Stromal rejection after big bubble deep anterior lamellar keratoplasty:  case series and review of literature.
abstract: OBJECTIVE
  The aim of this study was to report three cases of stromal rejection after deep anterior lamellar keratoplasty using big bubble technique in keratoconus.
  
  
  METHODS
  Deep anterior lamellar keratoplasty was performed in 3 cases of keratoconus (11-19 years of age) using the "big bubble" technique. All of them presented 4 to 19 months after uneventful surgeries with variable decrease of vision (1/200-20/200) along with foreign body sensation, mild pain, and corneal edema. Suture infiltrates were present in all eyes. Ultrasound pachymetry showed variable increase in central corneal thickness (711-894 μm). These patients with stromal rejection were administered pulse intravenous methylprednisolone, 500 mg in 150 mL of 5% dextrose and were started on 1% prednisolone acetate eye drops 1 hourly, moxifloxacin hydrochloride 0.5% 4 times a day along with homatropine 2% eye drops 4 times a day.
  
  
  RESULTS
  Complete recovery of the stromal rejections was attained with clear graft and recovery of visual acuity (≥20/40) in all eyes. Central corneal thickness returned to prerejection values in all the eyes after 7 days. There was no significant change in specular count.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty does not eliminate the risk of stromal rejection. Suture-related factors in the form of suture infiltrates and loose suture are an important risk factor for graft rejection. Graft rejection if treated promptly is reversible.
authors: Department of Ophthalmology, Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India. namrata103@hotmail.com
authors: Namrata
authors: N
authors: Sharma
authors: Asim Kumar
authors: AK
authors: Kandar
authors: Jeewan
authors: J
authors: Singh Titiyal
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D003319:Corneal Stroma; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D010276:Parasympatholytics / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D010276:Parasympatholytics