Abstract
BackgroundThe endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs). Here, we present a case of endothelial graft rejection with an endothelial rejection line occurring 1 year after the procedure.Case presentationA 58-year-old female presented with graft rejection 1 year following a DSAEK procedure. The episode started when she tapered down her loteprednol to once a day. Slit-lamp examination showed a mildly injected conjunctiva with 1+ corneal oedema. On the posterior surface of the cornea, there was an endothelial rejection line (Khodadoust line) with keratic precipitates and multiple areas of anterior synechia.ConclusionThe classic endothelial rejection line should be kept in mind as a rare sign of DSAEK graft rejection.
Highlights
The endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs)
The rate of graft rejection after DSAEK is significantly lower than that after Penetrating keratoplasty (PKP) [4, 8]. This is explained by the lower number of sutures, the absence of graft exposure to ocular-surface antigenpresenting cells, the lack of contact with stromal blood vessels, and the fact that DSAEK involves less immunogenic donor tissue than PKP [8, 9]
The endothelial rejection line (Khodadoust line) is an aggregation of lymphoid cells on the corneal endothelial side and is a sign of immunologic corneal allogenic graft rejection [10], which has been classically described after PKP
Summary
The endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs). Signs of endothelial graft rejection include keratic precipitates (KPs), corneal oedema and an anterior chamber reaction. According to different studies on Descemet stripping automated endothelial keratoplasty (DSAEK) complications, the 3-year incidence of immunologic graft rejection episodes ranges from 4 to 22% [1,2,3,4,5].
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