Graft rejection after femtosecond laser-assisted deep anterior lamellar keratoplasty: report of 3 cases.

PURPOSE: To report 3 cases of stromal rejection after deep anterior lamellar keratoplasty (DALK) assisted by a femtosecond laser. METHODS: Three keratoconus eyes of 2 men (22 and 30 years old) and 1 woman (24 years old) who had DALK with a 60-kHz femtosecond laser developed intrastromal graft rejection with superficial and deep neovascularization after 6, 15, and 12 months, respectively. All patients underwent confocal microscopy and were treated with topical steroid therapy. RESULTS: In vivo confocal microscopy revealed cellular inflammatory infiltrates in the subepithelial and middle stroma of the donor lamella without involvement of the endothelium. Graft rejection was rapidly reversed with topical steroid therapy, and a clear cornea was restored in all cases. CONCLUSIONS: Graft rejection remains a significant complication of lamellar surgery but is associated with good tissue restoration and complete visual recovery.