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A clinical case of bilateral corneal graft rejection: is it the influence of one eye rejection on the other?

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Abstract Details


To describe a case of bilateral corneal graft rejection one eye showing severe endothelial rejection and the other eye showing epithelial rejection.


Eye care, New Medcal Centre Speciality Hospital, Abu Dhabi, UAE


The author presents a case of 26 year old male patient who had undergone bilateral PKP primarily for keratoconus. Right eye PKP done 9 yrs ago and left eye 18 mths ago. He presented with acute left eye severe endothelial rejection 8 days after the onset of symptoms.He was treated with single dose 500mg intravenous methylprednisolone followed by oral and topical prednisolone. Three months later he presented with right eye epithelial rejection 3 days after the onset. He was treated with topical prednisolone.


Patient presented initially with OS BCVA of counting fingers at half metre and OD BCVA 6/9. OS showed marked corneal edema , endothelial rejection lines, Descemet's folds , KP's and intact corneal sutures,one loose with infiltration. OCT Cornea showed central corneal thickness(CCT) of 900 microns.Patient showed full recovery four weeks post treatment.BCVA improved to 6/36, CCT reduced to 540 microns. Three months later Patient presented with OD blurring of vision,BCVA 6/24. slitlamp examination showed corneal graft epithelial haze in the superior half with rejection line.OCTcornea showed normal CCT, 540 microns.Patient showed complete recovery with topical prednisolone after 4 weeks.


Despite late initiation of therapy and severe grade endothelial rejection, graft survived with pulse methylprednisolone , oral and topical corticosteroid therapy. Antigenic influence seems to be likely given the short lag period between the two eyes but invovement of corneal layer was different, endothelial rejection in one eye and other epithelial . Retained sutures with infiltration and corneal vascularization could have triggered endothelial rejection. Patients with bilateral corneal grafts who have suffered a rejection episode in one grafted eye should be counseled to seek prompt ophthalmic care in the event that they notice any untoward symptoms in either eye.

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