Stromal Graft Rejection

Definition

Stromal graft rejection is a host immunologic response to donor corneal tissue characterized by inflammatory cells infiltrating the stroma. Rejection typically occurs months to years following a corneal transplant, but at minimum, the graft must be previously clear for 2 weeks after keratoplasty for the diagnosis to be made. Of the types of corneal graft rejection, isolated stromal rejection is less frequent than endothelial and epithelial rejection and has fewer long-term consequences. It can be seen in conjunction with endothelial rejection.

Characteristic signs include peripheral haze or infiltrate that progresses toward the center of the graft. Stromal neovascularization may also be observed. In more severe cases of graft rejection, the stroma can become necrotic. Patients may complain of pain, redness, decreased visual acuity, irritation, or photophobia, but can often present asymptomatically.

In most cases, a good visual outcome is attained with prompt, aggressive...