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
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
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.