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Presumed Corneal Stromal Graft Rejection After Deep Anterior Lamellar Keratoplasty in a Patient with Systemic Lupus Erythematosis

Purpose: To report a case of presumed corneal stromal graft rejection after deep anterior lamellar keratoplasty in a patient with systemic lupus erythematosis (SLE). Methods: Deep anterior lamellar keratoplasty was performed using the “bug bubble” technique in the left eye of a 14-year-old patient with keratoconus. Her medical records revealed a history of SLE that was in remission. Immediate postoperative course was uneventful. A best-corrected visual acuity (BCVA) of 20/40 was achieved at the end of 6 months. She was advised to taper off and stop topical corticosteroids by the end of 9 months. The patient presented with a red eye and reduced vision 11 months after surgery. At the time of presentation, the BCVA was 20/200, and ultrasonic central corneal thickness (CCT) was 792 μm in the operated eye. The anterior chamber was found to be quiet, and posterior segment examination was unremarkable. A diagnosis of presumed immune-mediated corneal stromal graft rejection was made. Treatment was started in the form of 1% prednisolone acetate eye drops every hour and 0.5% moxifloxacin hydrochloride eye drops thrice times daily. Hundred milligrams of methylprednisolone in 150 mL of 20% dextrose was administered intravenously. Results: At the end of 2 weeks, the corneal edema cleared with a resultant CCT of 618 μm, and the BCVA improved to 20/40. Conclusions: Deep anterior lamellar keratoplasty does not eliminate the risk of corneal stromal rejection. Our patient had an associated history of SLE, which may necessitate a prolonged topical immunosuppression after corneal transplantation in these cases.