This 32 year-old woman was reviewed in the cornea clinic two week after a left penetrating keratoplasty for keratoconus.

a. What does the picture show?

Endothelial rejection line (Khodadoust line)

The picture shows a penetrating keratoplasty with interrupted sutures and on the graft there is a horizontal line resulting from keratic precipitates on the endothelium. It is a serious complication as the loss of endothelium lead to corneal oedema and may require regraft.

b. What other signs and symptoms may be present?

Anterior chamber reaction and corneal oedema are often present.
The patient may complain of photophobia, decreased vision and halo around the light.

c. What conditions can increase the development of this condition?

Corneal graft rejection is increased in the following:

• vascularization of the host bed where the graft is placed
• severe post-operative inflammation
• previous graft failure
• failure to comply with treatment.

c. How would you treat this patient?

The patient should be admitted to hospital for intensive topical steroid treatment and the response assessed daily. If the response were poor, systemic steroid may be required.

 
 

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