Alsawad Hajer I, Aljufairi Fatema M, Mahmood Abdulhameed H
Ophthalmology Department, Salmaniya Medical Complex, Manama, BHR.
Ophthalmology Department, Prince Sultan Military Medical City, Riyadh, SAU.
Cureus. 2021 Apr 21;13(4):e14612. doi: 10.7759/cureus.14612.
To report a rare case of unexplained bilateral corneal graft rejection one year after penetrating keratoplasty (PK) in an otherwise healthy individual, who was compliant with topical fluorometholone maintenance therapy.
An 18-year-old gentleman, who underwent successful, sequential, non-simultaneous, bilateral PK for advanced keratoconus, presented one year later with an acute endothelial rejection episode involving both eyes simultaneously. The rejection episode was reversed with a high dose of intravenous (IV) methylprednisolone pulse therapy over three days, topical cyclosporine-A 1%, and prednisolone acetate 1%, and then maintained on cyclosporine-A 1% eye drops, as the patient was a steroid responder. Conclusion and importance: Bilateral corneal graft rejection, although rare, can occur even several months after successful PK. Prompt management is crucial for the successful reversal of an acute corneal graft rejection episode. In steroid responders, Cyclosporine-A 1% can play a role in reducing the need for, or frequency of, potent steroid eye drops in the acute phase, and as a long-term steroid-sparing agent for maintenance.
报告一例罕见病例，一名身体健康且一直遵医嘱使用局部氟米龙维持治疗的个体，在穿透性角膜移植术（PK）一年后出现不明原因的双侧角膜移植排斥反应。
一名18岁男性，因晚期圆锥角膜接受了成功的、序贯的、非同时进行的双侧PK，一年后双眼同时出现急性内皮排斥反应。通过三天的高剂量静脉注射甲基强的松龙脉冲治疗、1%的局部环孢素A和1%的醋酸泼尼松龙，排斥反应得到逆转，随后由于患者是类固醇反应者，继续使用1%的环孢素A滴眼液维持治疗。结论及重要性：双侧角膜移植排斥反应虽然罕见，但即使在PK成功数月后仍可能发生。及时处理对于成功逆转急性角膜移植排斥反应至关重要。对于类固醇反应者，1%的环孢素A在急性期可减少强效类固醇滴眼液的使用需求或频率，并作为长期的类固醇节省剂用于维持治疗。
