Corneal Transplant Complications

Corneal Transplant Complications
		SYMPTOMS	Symptoms vary depending on complication: Graft rejection - blurry vision, pain \| Graft failure - blurry vision, pain, photophobia \| Infection - blurry vision, pain \| High refractive error - blurry vision
		SIGNS	Signs vary depending on complication: Graft rejection - keratic precipitates (Khodadoust line), subepithelial infiltrates (Krachmer spots), anterior chamber cells/flare, neovascularization, edema \| Graft failure - non-resolution of the above rejection signs \| Infection - neovascularization, discharge \| High refractive error - often a high degree of astigmatism (topography, keratometry)
		WORK-UP	Thorough history. Slit lamp examination
		TREATMENT
			Rejection and failure are treated aggressively with topical steroids (Pred Forte 1% q1h) and sometimes oral steroids \| A repeat graft may be indicated in the case of graft failure
			Infections are treated aggressively with topical antibiotics \| Endophthalmitis may require intravitreal and/or intravenous antibiotics/antifungals
			Glasses, soft contacts, or rigid contacts may correct high refractive error
		FOLLOW-UP	Daily during graft rejection/failure
		ADDITIONAL LAB \| TESTS	Topography for refractive error \| Endothelial cell count
		ETIOLOGY	Corneal transplant surgery
		DIFFERENTIAL DX	None
NOTES
	Note that there are a variety of corneal graft options, each with their own pros/cons and possible complications \| For example, PKP, DALK, DMEK, DSAEK, DWEK, etc.