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This study suggests that combined treatment with intravitreal bevacizumab and intravitreal triamcinolone improves structural outcome in patients with retinal vein occlusion. In our study, the combination of triamcinolone acetonide and bevacizumab offered no advantage over previously published results with intravitreal bevacizumab injections alone for improving vision at 6 months.

Purpose To describe the clinical presentation and management of late (>3.0 years) acute graft rejection in keratolimbal allograft (KLAL) recipients. Methods Multicenter, retrospective observational case series. 6 eyes of 6 patients with ocular surface transplant at a mean age of 36.2 years seen at 3 tertiary referral centers for acute graft rejection between 2007 and 2013. Main outcome measures included strength of systemic immunosuppression (SI) at the time of rejection, time to rejection, and clinical presentation of rejection. Results Preoperative diagnoses included total limbal stem cell deficiency (LSCD) due to aniridia (n = 2) or chemical injury (n = 4). Following an initially successful outcome, patients experienced late acute graft rejection at a mean time of 67.8 ± 24.1 months (range: 41 to 98) after KLAL while receiving suboptimal levels of SI due to medication taper (n = 5) or noncompliance (n = 1). Objective findings included an epithelial rejection line (n = 6), edema (n = 2), corneal epithelial irregularities (n = 2), and neovascularization (n = 1). Anti-rejection management consisted of topical corticosteroids (n = 6) and augmentation of SI therapy (n = 5). Conclusion These cases of late acute graft rejection in KLAL patients support the notion that allodonor cells can persist over the long run and remain at risk for immunologic rejection. It further underscores the fact that long-term success with KLAL may require extension of SI beyond the first few years, albeit at lower levels individualized to each patient.