Immunological Rejection in Descemet Stripping Automated Endothelial Keratoplasty

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Immunological Rejection in Descemet Stripping
Automated Endothelial Keratoplasty

• B. C. Hainline L. H. Suh S. H. Yoo E. Alfonso
  W. W. Culbertson T. P. O'Brien

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Financial Interest Disclosures

• Bryan Hainline None

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Purpose

• To evaluate the incidence and management issues
  of immunological rejection in Descemets
  Stripping with Automated Endothelial Keratoplasty
  (DSAEK).

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Methods

• Outcomes from 118 DSAEK cases performed by 7
  different surgeons at a tertiary center were
  analyzed retrospectively to assess the rate of
  immunological rejection.
• 118 eyes in 99 patients underwent DSAEK from May
  2005 to June 2007.
• Immunological rejection of the graft was defined
  as worsening of corneal edema with the appearance
  of keratic precipates on the graft.

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Results

• 7/118 eyes (6) had graft rejection.
• This was noted as early as the first
  postoperative month and as late as the eighth
  postoperative month.
• 1/7 eyes developed graft rejection after abrupt
  cessation of topical steroid therapy by the
  patient.

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Results

• All eyes were initially treated with hourly
  topical corticosteroid therapy.
• Two eyes received subconjunctival triamcinolone
  injections, of which one eye eventually failed.
• 2/7 developed eventual graft failure.

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Conclusions

• Immunological graft rejection is an uncommon and
  important complication in DSAEK.
• Management should include hourly topical steroids
  and in some circumstances subconjunctival
  triamcinolone injection.
• Careful postoperative steroid tapering should be
  considered to avoid this complication.