Purpose: To report on the clinical course of three patients who developed immunological rejection following Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure (GF) after penetrating keratoplasty (PK).
Case presentation: The cases were all males, and the underlying diseases for PK were herpetic keratitis, bullous keratopathy following cataract surgery, and post-trauma keratoleukoma. Two of the three cases underwent PK multiple times prior to DSAEK., Two of the three cases underwent DSAEK with Descemet's stripping. The period from DSAEK to immunological rejection was 26, 14, and 10 months, and all three cases exhibited corneal edema and keratic precipitates. One case, however, did not exhibit any subjective symptoms. None of the three cases exhibited vascularization of the PK graft, but all cases exhibited episodes of immunological rejection prior to the post-PK GF. All cases improved with subconjunctival steroid injection, increased eye drop dosage, or steroid semi-pulse therapy. One case, however, ultimately suffered from repeat GF.
Conclusions: All three cases had a history of post-PK immunological rejection. Hence, the relatively stronger immunological rejection noted after DSAEK for post-PK GF, compared with that after common DSAEK, suggested that post-PK antigen sensitization was affecting the post-DSAEK immunological rejection. After performing DSAEK for post-PK GF, any history of post-PK immunological rejection should be noted and careful follow-up observation should be implemented.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 942-948, 2018.