Rejection reaction after Descemet's membrane transplantation

An immunological rejection reaction is one of the common late keratoplastic complications that affect graft survival. According to the data available in the literature, the rejection reaction within 2 years after modified DSEK and DLEK endothelial transplantations is encountered in approximately 7.5% of cases while that after penetrating keratoplasty (PKP) was about 13%. The authors could find no data on the clinical manifestations and rate of a rejection reaction after modified DMEK endothelial transplantation. Eighty patients with Descemet's membrane graft were followed up, in whom 2 developed endothelial rejection crisis with stromal edema of the cornea without signs of inflammation, including precipitation, in the late periods (21 and 18 months, respectively) after Descemet's membrane transplantation. The performed ex juvantibus local corticosteroid therapy completely recovered corneal transparency and stopped an attack of a rejection reaction. During the mean follow-up of 17.2 ± 5.5 months (range 10 to 28 months), the rate of a rejection reaction after Descemet's membrane transplantation was 2.5%, which was less than that after DLEK, DSEK, and PKP. During corticosteroid therapy, corneal transparency recovery and rejection attack abolishment were achieved in both cases.

DMEK, DSEK, DMEK, DSEK, microinvasive descemetoplasty, endothelial dystrophy, endothelial keratoplasty