Interest Of In Vivo Confocal Microscopy In The Early Detection Of Corneal Graft Rejection: Report Of A Case.

Our objective is to evaluate in vivo confocal microscopy (IVMC) in the diagnosis and monitoring of patients presenting with corneal graft rejection following transfixing keratoplasty.

We report the case of a patient who underwent full-thickness keratoplasty on stage 4 bilateral karatoconus complicated by central corneal opacities.

The surgery carried out in 2018, with good clinical and functional evolution. 

In September 2024, the patient presented a progressive decline in visual acuity in the left eye with photophobia and tearing. 

Ophthalmological examinations show the beginning of graft rejection confirmed by IVMC in both eyes, more significant on the left.

A 33-year-old man with a history of type 1 diabetes on insulin, and full-length keratoplasty in both eyes for bilateral stage 4 karatoconus complicated by central corneal opacities, 7 years ago.

He presented for consultation due to a progressive decline in visual acuity in the left eye over the past three months. 

On clinical examination, corrected visual acuity is 5/10th P2 in the right eye and 2/10th P3 in the left eye. 

Slit lamp examination reveals a relatively clear cornea with the presence of a few descmetic folds in both eyes.

Fundus examination revealed no detectable abnormalities.

IVMC found in both eyes: the presence of dendritiform cells in the endothelium and subepithelial layers more marked on the left.

General and local immunosuppressive and corticosteroid treatment was initiated with clinical and functional improvement.

IVMC is a revolutionary tool which is of interest in the diagnosis and post-operative monitoring of corneal transplants.

Dendritiform cells are inflammatory cells which announce the occurrence of graft rejection even before the appearance of corneal edema and therefore screen subjects at risk.

Anti-rejection treatment started early allows an extension of the lifespan of the graft and improves the final visual prognosis.

In vivo confocal microscopy is a non-invasive, reproductive imaging method which allows in vivo histological analysis of the grafted cornea; its use in screening for graft rejection allows early and effective treatment.