Acute corneal graft rejection following photorefractive keratectomy for post-penetrating keratoplasty high astigmatism

AIM: To report an unusual case of acute graft rejection after photorefractive keratectomy, performed to correct high residual astigmatism after penetrating keratoplasty for keratoconus. SUBJECT: A 46-years-old woman, 23 years after penetrating keratoplasty for keratoconus, underwent a customized trans-epithelial no-touch photorefractive keratectomy in the right eye for the correction of high residual myopic astigmatism (-1.50sph -11cyl@110). During the procedure an interruption of the laser ablation verified and subsequently the surgical time was 7 minutes longer. The procedure was completed without any other complications. RESULTS: Five days after surgery an acute immune rejection occurred. The patient was immediately treated with topical and systemic steroid drugs. Three days later corneal transparency progressively improved. Two weeks later the graft rejection was completely resolved. After a follow-up of 3 months both UDVA and CDVA significantly improved to 20/32 and 20/25 (-1sph +2cyl@50) respectively. CONCLUSION: The risk of corneal graft rejection may be increased by some inflammatory trigger conditions like refractive laser treatments. An immediate and appropriate medical treatment was effective in solving this serious complication.