Presumed stromal graft rejection after deep anterior lamellar keratoplasty

PURPOSE: To demonstrate the development of presumed immune-mediated stromal rejection after deep anterior lamellar keratoplasty and its reversal after initiation of intensive topical corticosteroid therapy. METHODS: Observational case report carried out with the approval of the hospital institutional review board. RESULTS: Stromal edema and peripheral vascularization developed 16 months after deep anterior lamellar keratoplasty for keratoconus in a 13-year-old girl. After 2 weeks of intensive topical corticosteroids, complete reversal of stromal edema and regression of peripheral vascularization occurred, with full recovery of visual function. CONCLUSION: The clinical appearance and response to therapy in this case support the diagnosis of immune-mediated stromal rejection. Ophthalmologists should be aware that sight-threatening stromal rejection may occur in lamellar corneal grafts.