Incidence of Stromal Rejection in Deep Anterior Lamellar Keratoplasty in North Eye Center/Erbil

Authors

  • Marwan Fareeq Shaheen MBChB., Kurdistan Higher Council of Medical Specialties- Ophthalmology; Eye Teaching Hospital- Erbil-Kurdistan Region/Iraq
  • Neshiteman Hashim Abdulrahman Consultant Ophthalmologist? FIBMS- Ophthalmology, Kurdistan Higher Council of Medical Specialties, Erbil -Iraq

DOI:

https://doi.org/10.56056/

Keywords:

Incidence, Keratoplasty, Keratoconus, Risk factors, Stromal rejection

Abstract

Background and objectives: Deep anterior lamellar keratoplasty has emerged as a preferred surgical option for corneal diseases, with its primary advantage being the preservation of endothelial cell density, thus reducing the risk of endothelial graft rejection. This study aimed to assess the incidence of stromal rejection in Deep anterior lamellar keratoplasty among patients in Erbil city, Kurdistan Region of Iraq. 

Methods: This retrospective cross-sectional study analyzed the incidence of stromal rejection in 477 patients who underwent deep anterior lamellar keratoplasty at the North Eye Center, Erbil, Kurdistan Region of Iraq, from March 2016 to January 2023. Of these, 28 patients developed stromal rejection. Medical records were reviewed to identify risk factors associated with stromal rejection, with diagnoses confirmed via slit lamp examination and visual acuity measurements. Data were analyzed using SPSS version 28, with significance set at p ? 0.05. Ethical approval was obtained, and patient confidentiality was maintained.

Results: The incidence of stromal rejection in deep anterior lamellar keratoplasty was 5.87% among the patients. The study revealed a statistically significant association between rejection and clinical assessment, with loose sutures being a significant risk factor (p = 0.001). Specifically, 50% of the patients who experienced stromal rejection had loose sutures. Additionally, stromal neovascularization contributed to 25% of the rejection cases (p = 0.001). Treatment primarily involved antibiotics and steroids, with lubricants having no significant impact on rejection rates. Male predominance was observed among patients (72.1% male, 27.9% female), with no significant gender association with rejection (p = 0.341).

Conclusion: The findings underscore the efficacy of Deep anterior lamellar keratoplasty in treating corneal disorders while highlighting the importance of vigilant postoperative care, particularly in monitoring suture integrity to prevent rejection.

Downloads

Download data is not yet available.

References

1. Hayawi AJ, Khaudhair AS. Prevalence of Keratoconus among Iraqi Patient Attending Ophthalmology Refractive Surgery Clinics. Adv. Res. J. Med. Clin. Sci. 2022;8(07):926-31. doi: 10.15520/arjmcs. v8i07.457/

2. Feizi S, Javadi MA, Fekri Y. Use of deep anterior lamellar keratoplasty (DALK) for keratoconus: indications, techniques and outcomes. Exp. Rev. Ophthalmol. 2016;11(5):347-59. doi: 10.1080/17469899.2016.1222904/

3. Khattak A, Nakhli FR, Al-Arfaj KM, Cheema AA. Comparison of outcomes and complications of deep anterior lamellar keratoplasty and penetrating keratoplasty performed in a large group of patients with keratoconus. Int. Ophthalmol. 2018; 38:985-92. doi: 10.1007/s10792-017-0548-9/

4. Giannaccare G, Weiss JS, Sapigni L, Bovone C, Mattioli L, Campos EC, et al. Immunologic stromal rejection after deep anterior lamellar keratoplasty with grafts of a larger size (9 mm) for various stromal diseases. Cor. 2018;37(8):967-72. doi: 10.1097/ICO.0000000000001584/

5. Thanitcul C, Mathews P, Woreta FA, Akpek EK, Varadaraj V, Srikumaran D. Surgeon preference for keratoplasty techniques and barriers to performing deep anterior lamellar keratoplasty. Cor. 2021;40(11):1406-12. doi: 10.1097/ICO.0000000000002644/

6. Arundhati A, Chew MC, Lim L, Mehta JS, Lang SS, Htoon HM, et al. Comparative study of long-term graft survival between penetrating keratoplasty and deep anterior lamellar keratoplasty. Amer. J. Ophthalmol. 2021; 224:207-16. doi: 10.1016/j.ajo.2020.11.006/

7. Shukur ZY. The Visual Acuity Outcome, Rate of Rejection and Mean Intraocular Pressure Contrasted between PKP and DALK Techniques in a Sample of Iraqi Patients with Corneal Grafting. Int. Med. J. 2021;28(1):48-52.

8. Feizi S, Javadi MA, Karimian F, Bayat K, Bineshfar N, Esfandiari H. Penetrating keratoplasty versus deep anterior lamellar keratoplasty for advanced stage of keratoconus. Amer. J. Ophthalmol. 2023; 248:107-15. doi: 10.1016/j.ajo.2022.11.019/

9. Hopkinson C, Romano V, Kaye R, Steger B, Stewart R, Tsagkataki M, et al. The influence of donor and recipient gender incompatibility on corneal transplant rejection and failure. Amer. J. Transplant. 2017;17(1):210-7. doi: 10.1111/ajt.13926/

10. Kasamatsu H, Yamaguchi T, Yagi-Yaguchi Y, Nishisako S, Tomida D, Akiyama M, et al. Incidence and Clinical Features of Immunologic Rejection After Deep Anterior Lamellar Keratoplasty. Cor. 2022:10.1097. doi: 10.1097/ICO.0000000000003444/

11. Zhou Y, Wang T, Tuli SS, Steigleman WA, Shah AA. Overview of corneal transplantation for the nonophthalmologist. Transplant. Dir. 2023;9(2): e1434. doi: 10.1097/TXD.0000000000001434/

12. Feizi S, Javadi MA, Javadi F, Malekifar P, Esfandiari H. Suture-related complications after deep anterior lamellar keratoplasty for keratoconus. Gra. Arch. Clin. Exp. Ophthalmol. 2023:1-8. doi: 10.1007/s00417-023-06298-5/

13. Hirano K, Tanaka H, Kato K, Araki-Sasaki K. Graft rejection-like reactions in the early postoperative period after deep anterior lamellar keratoplasty for keratoconus: a retrospective study. Clin. Ophthalmol. 2018:2315-22. doi: 10.2147/OPTH.S178161/

14. Pellegrini M, Scorcia V, Giannaccare G, Lucisano A, Vaccaro S, Battaglia C, et al. Corneal neovascularisation following deep anterior lamellar keratoplasty for corneal ectasia: incidence, timing and risk factors. Brit. J. Ophthalmol. 2022;106(10):1363-7. doi: 10.1136/bjophthalmol-2021-319339/

15. Fogla R, Soni D. Acute Graft Rejection. In: Sharma B, Titiyal JS, editors. Corneal Emergencies. Sing.: Spri. Nat. Sing.; 2022. p. 259-74.

Downloads

Published

2026-03-01

Issue

Section

Articles

How to Cite

Incidence of Stromal Rejection in Deep Anterior Lamellar Keratoplasty in North Eye Center/Erbil. (2026). AMJ (Advanced Medical Journal) , 11(1), 7-13. https://doi.org/10.56056/