Repeating Dalk Procedure In Case Of Stromal Graft Rejection

Published 2022 - 40th Congress of the ESCRS

Reference: PO030 | Type: Case report | DOI: 10.82333/14hx-tq89

Authors: Ghada samir Mohamed* ¹

¹memorial institute of ophthalmic researches,memorial institute of ophthalmic researches,Cairo,Egypt

to prove the possibility of successfuly repeating DALK surgery in some indications as stromal graft rejection

Memorial institute of ophthalmic researches

A 24 years old male patient having a history of keratoconus in both eyes, had undergone deep anterior lamellar keratoplasty (DALK) in left eye. The surgery was uneventful with no tears at descemt’s membrane (DM). 1 week postoperative, the patient presented with corneal edema mainly stromal edema and haze. Anterior segment optical coherence tomography was performed confirming that there was no DM detachment or tear. The stromal edema was suspected to be due to severe inflammatory graft reaction. The topical steroid dose (Betamethasone phosphate 0.1%) was increased to be six times per day. The patient was followed up every week for one month. No improvement of stromal edema, epithelial erosions and start of sutures loosening were noticed. These findings suggested starting melting and graft rejection. Decision of repeating DALK was taken. During surgery: Old graft was removed, Pre descemetic membrane was clear. New donor graft was put after removal of its DM, finally suturing of the graft by 10/0 silk. 1 week postoperative, the graft was clear with no inflammatory reactions. The patient was followed up for one year and the graft was still clear with no edema. Best corrected visual acuity was 0.5 on Snellen chart.

DALK procedure is possible to be repeated to manage postoperative stromal graft rejection resistant to medical treatment.