Anterior synechiae related to an incipient Descemet's membrane endothelial keratoplasty (DMEK) allograft rejection

Carreras-Castañer, X.; Batlle-Ferrando, S.; Marin-Martínez, S.; Miguel, Lucía; Feu-Basilio, Silvia; Peraza‐Nieves, Jorge

doi:10.1016/j.jfo.2020.01.033

Cited by 2 publications

(4 citation statements)

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“… Retrospective analysis- 78 patients 80 eyes Mean donor age 83.6 ± 3.7 years (range: 80–100 years), mean recipient age 67.2 ± 6.9 years (range: 60–89 years), the preoperative value of 1.36 ± 0.67 Old age, low endothelial cell count Conjunctival congestion, corneal edema, and AC reaction Topical steroids Graft failure 2 eyes at 1 year, graft rejection 2 eyes, 1 reversed by medical management 7 Besek et al 12 Int Ophthalmol, 2022 Jan;42(1):269–279 Retrospective analysis 150 eyes Fuch’s Corneal Endothelial Dystrophy, Bullous keratopathy The primary graft failure rate was 11.3%, Secondary graft failure rate was 9.3%, and the allograft rejection rate was 4.7%. 8 Hayashi et al 91 Cornea 2021 Jun 1;40(6):685–689 Retrospective analysis of 24 patients 24 eyes Mean age- 65.0 years Failed Optical Penetrating Keratoplasty, vascularized corneas Corneal edema, superficial vascularization, KPs at BOC, Graft rejection 1 eye, no episode of primary graft failure 9 Castaner et al 43 J Fr Ophtalmol, 2020 Dec;43(10):e389-e391. Case Report 1 patient 83-year male Anterior synechiae, old age Corneal edema, KPs at the back of the cornea, anterior chamber cells, KPs at BOC Topical dexamethasone 1 mg/mL 6 times per day Clear Cornea at 2 months with no signs of rejection 10 Boutin et al 29 Eur J Ophthalmol, 2021 Jul;31(4):2121–2126.…”

Section: Methods Of Searchmentioning

confidence: 99%

“…The presence of peripheral anterior synechiae has been reported in a few cases as a sign associated with DMEK graft rejection. 38 , 43 Study of eyes with anterior synechiae in murine models showed that the synechiae could induce cytotoxic T cells activity, probably explaining the increased risk of rejection. 39 Discontinuation of steroid use one year after surgery has been prospectively studied, and discontinuation leads to around 6% incidence of immune reaction.…”

Section: Risk Factors For Descemet Membrane Endothelial Keratoplasty ...mentioning

confidence: 99%

“…A detailed literature review of DMEK Graft Rejection over the past 5 years is listed in Table 1 (Larger case series) and 2 (Case reports). 9 , 12 , 17 , 18 , 28–30 , 37 , 38 , 43 , 46–48 , 74 , 76 , 82–98 …”

Section: Future Perspectivesmentioning

confidence: 99%

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Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Gurnani¹,

Kaur²,

Lalgudi³

et al. 2023

OPTH

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Descemet membrane endothelial keratoplasty (DMEK) is a corneal endothelial transplantation procedure with selective removal of a patient’s defective Descemet membrane and endothelium. It is replaced with a healthy donor Descemet membrane and endothelium without a stromal component. Corneal graft rejection can be at the level of epithelium, stroma as well endothelium. DMEK graft rejection is relatively less common than rejection with DSAEK or penetrating keratoplasty, and a good outcome may be achieved with prompt management. The clinical picture of DMEK rejection is usually similar to endothelial rejection in Descemet Stripping Endothelial Keratoplasty (DSEK/DSAEK), which generally manifests as pain, redness, reduction in visual acuity, stromal edema, endothelial rejection line, keratic precipitates at the back of the cornea and corneal neovascularization. However, more subtle forms of rejection or immune reactions are more common in DMEK compared to DSAEK eyes. Early clinical diagnosis, prompt intervention, and meticulous management safeguard visual acuity and graft survival in these cases. Intensive topical steroids form the mainstay in the management of DMEK rejection. Sometimes, oral or intravenous steroids or other systemic immunomodulators may be required. DMEK graft failure can be primary or secondary, and failure usually requires a second procedure in the form of repeat DMEK or DSEK or penetrating keratoplasty (PKP). A detailed literature search was performed using search engines such as Google Scholar, PubMed, and Google books, and a comprehensive review on DMEK rejection was found to be lacking. This review is a comprehensive update on the risk factors, pathophysiology, primary and secondary graft failure, recent advances in diagnosis, prevention of rejection, and updates in the management of DMEK rejection. The review also discusses the differential diagnosis of DMEK failure and rejection, prognosis, and future perspectives considering DMEK failure and rejection.

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Section: Methods Of Searchmentioning

confidence: 99%

Section: Risk Factors For Descemet Membrane Endothelial Keratoplasty ...mentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Gurnani¹,

Kaur²,

Lalgudi³

et al. 2023

OPTH

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“…Postoperative rejection rates are reported to range between 4.9% and 28.9% for PK, 1.6% and 8.5% for DSAEK, and 0% and 2.4% for DMEK [7, 8]. Peripheral anterior synechiae are one of the risk factors for graft rejection after PK [9]; however, only a few studies have reported graft failure after DMEK with anterior synechia [10]. Herein, we report a case of graft rejection after DMEK for bullous keratopathy induced by laser iridotomy (LI) where peripheral anterior synechiae were observed postoperatively.…”

Section: Introductionmentioning

confidence: 99%

Corneal Graft Rejection after Descemet’s Membrane Endothelial Keratoplasty with Peripheral Anterior Synechiae

Miyoshi

Ono

Seki

et al. 2022

Case Rep Ophthalmol

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Descemet’s membrane endothelial keratoplasty (DMEK) for patients with corneal endothelial loss rarely results in graft rejection. Herein, we report a rare case of graft rejection following DMEK, in which peripheral anterior synechiae were observed postoperatively. A 66-year-old woman was referred to our hospital after complaints of decreased visual acuity of her right eye after laser iridotomy for primary angle closure 3 years earlier. Her right cornea had bullous keratopathy with mild cataract, and her best-corrected visual acuity (BCVA) was 20/40. After cataract surgery, DMEK was successfully performed, except for development of peripheral anterior synechiae at the temporal cornea. Her BCVA recovered to 20/20. However, when topical instillation was changed to 0.1% fluorometholone from 0.1% betamethasone once a day, corneal edema reappeared with hyperemia, mutton fat keratic precipitates (KPs), and cells in the anterior chamber. The BCVA worsened to 20/32. Graft rejection was diagnosed, and subconjunctival injection of dexamethasone was performed 3 times, once every few days, with 0.1% topical betamethasone instillation. Subsequently, the hyperemia, mutton fat KPs, and cells in the anterior chamber disappeared with a recovered BCVA of 20/20 after 2 weeks. Ten months after graft rejection, there was no recurrence of intraocular inflammation, and only topical betamethasone was administered twice daily. It is important to exercise caution in cases with peripheral anterior synechiae after DMEK. Long-term steroid administration is necessary to prevent graft rejection.

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Anterior synechiae related to an incipient Descemet's membrane endothelial keratoplasty (DMEK) allograft rejection

Cited by 2 publications

References 3 publications

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

Corneal Graft Rejection after Descemet’s Membrane Endothelial Keratoplasty with Peripheral Anterior Synechiae

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