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2007 OMIG, Abstract 5

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Stromal Graft Rejection: A Silent Menace
Jerome C. Ramos-Esteban, MD, William J. Dupps, MD, PhD, David M. Meisler, MD, Bennie H. Jeng, MD
Cole Eye Institute, Cleveland, OH

Purpose: To report three patients who developed an asymptomatic form of stromal graft rejection after penetrating or deep anterior lamellar keratoplasty.
Methods: A retrospective chart review.
Results: Three young African American male patients (ages ranging between 33 and 36 years of age) with a diagnosis of keratoconus underwent penetrating keratoplasty (n=2) or deep anterior lamellar keratoplasty (n=1) for visual rehabilitation. All three patients developed at least one episode of symptomatic epithelial graft rejection which was successfully treated with topical corticosteroids. During routine post-operative scheduled visits, all of these patients presented with physical evidence of stromal graft rejection characterized by deep stromal graft neovascularization associated with focal stromal edema and perivascular deposition of inflammatory cells. At the time of diagnosis, none of these patients was noted to be symptomatic. Despite aggressive treatment in one of the cases, stromal rejection progressed to graft failure with a resultant visual acuity of 20/400.
Conclusion: Stromal graft rejection can present in entirely asymptomatic patients on routine examination.  When detected, stromal rejection must be aggressively treated and can have serious visual consequences.
Disclosure code: N

Financial Support: Supported in part by a Research to Prevent Blindness Challenge Grant, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine, and NIH 8K12 RR023264 Multidisciplinary Clinical Research Training Awards (WJD and BHJ).


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