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Stromal rejection after deep anterior lamellar keratoplasty utilizing grafts of large-diameter (9mm)

Poster Details

First Author: G.Giannaccare ITALY

Co Author(s):    L. Sapigni   C. Bovone   V. Scorcia   M. Busin           

Abstract Details


To evaluate the incidence and outcomes of stromal rejection occurring after deep anterior lamellar keratoplasty (DALK) employing grafts of large diameter (9mm) in eyes with various types of stromal disease.


Department of Ophthalmology, Villa Igea Hospital, Forl�Ã�¬, Italy; International Institute for Research and Training in Ophthalmology, Forl�Ã�¬, Italy.


All medical charts of patients who underwent DALK since January 2012 at our Institution were reviewed. DALK was performed in a standardized fashion including: 9mm deep trephination of the recipient; pneumatic dissection; clearing of the central 6 mm by removal of the big-bubble ceiling or hand dissection; suturing of a 9 mm donor lamella. Each eye was assigned to either: Group 1=Keratoconus (KC); Group 2=Non-vascularized corneas other than KC; Group 3=Vascularized corneas. Episodes of stromal rejection and outcomes 6 months after treatment with topical dexamethasone 0.1% (2-hourly for 14 days and slowly tapered off over a 6-month period) were noted.


During the study period, in total 20/376 eyes (5.3%) of 352 patients experienced an episode of stromal rejection. Repeat rejection episodes were not seen. Stromal rejection was recorded in 17/286 eyes (5.9%) of Group 1, 2/55 eyes (3.6%) of Group 2 and 1/35 eyes (2.8%) of Group 3. The time interval between DALK and the onset of the rejection episode ranged from 1 to 24 months (average = 11.6 months). Within 6 months from onset, steroidal treatment had succeeded in reverting best-corrected visual acuity, central corneal thickness and endothelial cell count to pre-rejection values in all cases.


Utilizing grafts of large diameter (9 mm) for DALK does not increase the risk of stromal rejection, regardless of the indication for surgery. DALK grafts larger than conventional ones (8-8.25 mm) used for penetrating keratoplasty may combine the advantages of minimizing the risk and adverse effects of immunologic rejection with those of improved optics related to the increased diameter.

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