DSEK graft rejection signs differ from PK

This retrospective consecutive case series of 598 eyes that underwent Descemet stripping with endothelial keratoplasty (DSEK) reported graft rejection episodes in 54 eyes of 48 patients. Thirty-three percent of these eyes were asymptomatic and diagnosed during routine exams. Clinical signs included keratic precipitates (69 percent), diffuse corneal edema (11 percent), both (20 percent) and conjunctival injection (28 percent). Some rejection patients admitted poor topical corticosteroid compliance. None demonstrated endothelial rejection lines, epithelial rejection lines or subepithelial infiltrates often seen with penetrating keratoplasty rejection. Graft failure occurred in four eyes (7 percent), which were successfully regrafted with DSEK.