Stromal Rejection After Smile for the Correction of Astigmatism After Graft Publisher Pubmed



Hashemi H¹ ; Aghamirsalim M² ; Asgari S¹
Source: Journal of Refractive Surgery Published:2019

Abstract

PURPOSE: To describe a case of stromal rejection in a 46-year-old man after small incision lenticule extraction (SMILE) for the correction of residual astigmatism following deep anterior lamellar keratoplasty (DALK). METHODS: Case report. RESULTS: Nine years after an uneventful DALK in the left eye, the patient (uncorrected distance visual acuity [UDVA] = 20/200, corrected distance visual acuity [CDVA] = 20/32, and refraction = -3.25 -4.25 × 165°) underwent SMILE using the VisuMax femtosecond laser platform (Carl Zeiss Meditec, Jena, Germany). The next day, the UDVA, CDVA, and refraction were 20/40, 20/32, and -1.25 -0.50 × 15°, respectively. One week later, the patient presented complaining of pain, photophobia, and blurred vision; at this time, there was a reduction in UDVA to 20/400 and CDVA to 20/63. With a diagnosis of stromal rejection, the patient was treated with corticosteroids (sub-Tenon injection and oral). Five months later, UDVA was 20/40, CDVA was 20/25, and refraction was -1.25 -0.75 × 90°. The graft had completely cleared. CONCLUSIONS: SMILE can be an effective alternative for the correction of astigmatism after DALK, but the risks of inflammatory responses and graft rejection call for caution. Copyright © SLACK Incorporated