Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty

Hirotsugu Kasamatsu; Takefumi Yamaguchi; Yukari Yagi-Yaguchi; Sota Nishisako; Daisuke Tomida; Masato Akiyama; Toshinori Murata; Jun Shimazaki

doi:10.1097/ICO.0000000000003444

Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty

Cornea. 2023 Nov 30. doi: 10.1097/ICO.0000000000003444. Online ahead of print.

Authors

Hirotsugu Kasamatsu^{1

2}, Takefumi Yamaguchi¹, Yukari Yagi-Yaguchi¹, Sota Nishisako³, Daisuke Tomida¹, Masato Akiyama⁴, Toshinori Murata², Jun Shimazaki¹

Affiliations

¹ Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.
² Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan.
³ Cornea Center and Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; and.
⁴ Department of Ocular Pathology and Imaging Science, Graduate School of Medical Sciences, Kyushu University, Hakata, Japan.

PMID: 38049155
DOI: 10.1097/ICO.0000000000003444

Abstract

Purpose: The aim of this study was to investigate the incidence and clinical features of immunologic rejection after deep anterior lamellar keratoplasty (DALK).

Methods: This study included 411 patients (464 eyes, median age [interquartile range; IQR] 55.8 years [36.1-69.5]) who underwent DALK at Tokyo Dental College between June 1997 and 2021. Of 411 patients, 24 (24 eyes [5.2%], 51.9 years [IQR 31.6-65.4]) developed immunologic rejection. We characterized the clinical features, risk factors associated with immunologic rejection, and prognosis.

Results: The interval between DALK and immunologic rejection was 14.5 (range, 5-78) months. Immunologic rejection occurred after cessation/reduction of topical steroid in 9 (47.4%) and suture removal in 4 eyes (21.1%). The postoperative duration of topical steroid use in eyes with immunologic rejection was significantly shorter (10.0 months, [IQR 6.0-14.0]) than those without immunologic rejection (28.3 [IQR 15.8-42.7], P = 0.001). Immunologic rejection manifested as stromal edema in 19 (100.0%), ciliary hyperemia in 17 (89.5%), keratic precipitates in 13 (68.4%), epithelial edema in 13 (68.4%), infiltration in 9 (47.4%), corneal opacity in 4 (21.1%), and Descemet membrane detachment in 2 eyes (10.5%). After treatment, corneal clarity was restored in 17 eyes (89.5%); however, immunologic rejection led to corneal endothelial decompensation in 2 eyes (10.5%). Endothelial cell density decreased from 1795.7 ± 722.6 to 1651.6 ± 655.6 cells/mm2 after immunologic rejection (P = 0.074).

Conclusions: Post-DALK immunologic rejection was associated with specific clinical triggers such as reduction/cessation of topical steroids or suture removal.