Immunologic Stromal Rejection After Deep Anterior Lamellar Keratoplasty With Grafts of a Larger Size (9 mm) for Various Stromal Diseases

Cornea. 2018 Aug;37(8):967-972. doi: 10.1097/ICO.0000000000001584.


Purpose: To evaluate the rate and outcomes of immunologic stromal rejection occurring after large deep anterior lamellar keratoplasty (DALK) and the effect of the underlying disease on the cumulative probability of rejection.

Methods: This was a retrospective chart review of all eyes that underwent a 9-mm DALK at Ospedali Privati Forlì (Forlì, Italy). On the basis of preoperative diagnosis, eyes were assigned to group 1: keratoconus, group 2: stromal disease with a low risk for rejection, or group 3: stromal disease with a high risk for rejection. The cumulative probability of experiencing a rejection episode over time was assessed by Kaplan-Meier analysis and was compared among the 3 groups using the log-rank test. Values of corrected distance visual acuity, central corneal thickness, and endothelial cell density before and 6 months after rejection were compared.

Results: Twenty of 377 eyes (5.3%) experienced an episode of stromal rejection [17/265 (6.4%) in group 1, 2/71 (2.8%) in group 2, and 1/41 (2.4%) in group 3]. The mean time interval between DALK and the rejection onset was 11.8 months (range 1-24). The cumulative probability of rejection episodes did not differ significantly among the 3 groups. All episodes resolved within 6 months after the onset, with no significant differences between prerejection and 6-month postrejection values of corrected distance visual acuity, central corneal thickness, and endothelial cell density.

Conclusions: The rate of immunologic stromal rejection after large 9-mm DALK is within the range reported in the literature for conventional DALK, regardless of the indication for surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Corneal Diseases / diagnosis
  • Corneal Diseases / surgery*
  • Corneal Stroma / pathology*
  • Female
  • Follow-Up Studies
  • Graft Rejection / diagnosis
  • Graft Rejection / immunology*
  • Humans
  • Immunity, Cellular*
  • Keratoplasty, Penetrating / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications*
  • Prognosis
  • Retrospective Studies
  • Young Adult