Graft Rejection After Deep Anterior Lamellar Keratoplasty At A Tertiary Care Center

Deep anterior lamellar keratoplasty (DALK) has lower risk of graft rejection in comparison to penetrating keratoplasty (PK) as it eliminate the potential for endothelial rejection, which is the primary cause of graft failure following PK.

Our aim in this study is to evaluate the characteristics and outcomes of rejection after DALK at a tertiary care center in Saudi Arabia.

The study was conducted at King Abdulaziz university hospital, King Saud University Medical City, Riyadh, Saudi Arabia, a 104-bed capacity tertiary hospital, and a specialized academic center in ophthalmology and otolaryngology.

A retrospective observational study. The clinical records of 42 cases of DALK performed at our center between January 2019 and December 2023 were reviewed.

The graft rejection cases were identified and analyzed in terms of clinical and surgical aspects. The clinical presentation of the cases of rejection was compared to the findings reported in similar puplished studies.

Of the 42 patients included in this study, 3 (7.1%) patients had an episode of graft rejection. The mean age of patients with rejection at presentation was 30.6 years, compared to 33.5 years for those without rejection. Patients with rejection had a mean follow-up duration of 16.6 months, compared to 25.7 months for those without rejection. All the cases of rejection have completely recovered with topical prednisolone acetate 1% administered hourly. The mean recovery period was 5.6 days. One of the rejection cases was a steroid responder, and he was managed with topical aqueous suppressants and a faster tapering of the topical steroid. Another patient reported poor compliance with the topical steroids.

While DALK offers significant advantages over PK, graft rejection remains a potential complication. Fast tapering and poor compliance to topical steroid might carry a higher risk of rejection. Early presentation and timely treatment of rejection after DALK carry a good prognosis and can prevent graft failure.