{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:28:34Z","timestamp":1786649314600,"version":"build-2736575974"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To report the clinical features and management outcomes of rejection after deep anterior lamellar keratoplasty (DALK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The clinical features, indications, predisposing risk factors, management, and outcome of six eyes of six patients with rejection after DALK were analyzed retrospectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The median time of rejection from the day of surgery was 12 (range 3\u201336) months. Median duration of symptoms was 4 (range 2\u201328) days. The indication for DALK was keratoconus in all eyes. The clinical features at presentation included graft haze, vascularization, and melt at the graft\u2013host junction. The risk factors noted were noncompliance to steroids in all eyes, vernal conjunctivitis (four eyes), and eccentric graft (one eye). The rejection episode reversed with topical steroids in all eyes and intravenous methylprednisolone in one eye. One eye developed secondary fungal keratitis after initial recovery and one eye had a second episode of rejection 3 months later, which resulted in progressive vessels and lipid keratopathy in the visual axis. The median best corrected visual acuity was 20\/40 (range 20\/30\u201320\/200).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Severe stromal rejection can present with graft melt. Repeat episodes of rejection can occur on sudden cessation of topical steroids. Prompt recognition of clinical signs and symptoms with timely management helps in quick reversal of the rejection episode. Reversal of graft rejection results in good visual outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_3344_23","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T12:09:15Z","timestamp":1720699755000},"page":"83-87","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Clinical profile and outcomes of rejection after deep anterior lamellar keratoplasty in keratoconus"],"prefix":"10.4103","volume":"73","author":[{"given":"Priyanka","family":"Sudaboina","sequence":"first","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Chaurasia","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somasheila","family":"Murthy","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"R1-20260424","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1016\/j.ophtha.2004.02.010","article-title":"Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus","volume":"111","author":"Watson","year":"2004","journal-title":"Ophthalmology"},{"key":"R2-20260424","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0002-9394(02)01523-4","article-title":"Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty","volume":"134","author":"Shimazaki","year":"2002","journal-title":"Am J Ophthalmol"},{"key":"R3-20260424","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/ICL.0b013e31824ccb91","article-title":"Stromal rejection after big bubble deep anterior lamellar keratoplasty: Case series and review of literature","volume":"39","author":"Sharma","year":"2013","journal-title":"Eye Contact Lens"},{"key":"R4-20260424","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/01.ico.0000240080.99832.f3","article-title":"Deep Anterior Lamellar Keratoplasty (DALK): Visual outcome and complications for a heterogeneous group of corneal pathologies","volume":"26","author":"Noble","year":"2007","journal-title":"Cornea"},{"key":"R5-20260424","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1007\/s10792-021-01778-1","article-title":"DSAEK or DMEK for failed penetrating keratoplasty: A systematic review and single-arm meta-analysis","volume":"41","author":"Wu","year":"2021","journal-title":"Int Ophthalmol"},{"key":"R6-20260424","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.ophtha.2006.01.006","article-title":"Patterns of rejection after deep lamellar keratoplasty","volume":"113","author":"Watson","year":"2006","journal-title":"Ophthalmology"},{"key":"R7-20260424","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/ICO.0b013e31823f8a99","article-title":"Stromal rejection following deep anterior lamellar keratoplasty: Implications for postoperative care","volume":"31","author":"Olsen","year":"2012","journal-title":"Cornea"},{"key":"R8-20260424","doi-asserted-by":"crossref","first-page":"100768.","DOI":"10.1016\/j.preteyeres.2019.07.001","article-title":"Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation","volume":"73","author":"Hos","year":"2019","journal-title":"Prog Retin Eye Res"},{"key":"R9-20260424","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/01.ico.0000141230.95601.95","article-title":"Presumed stromal graft rejection after deep anterior lamellar keratoplasty","volume":"24","author":"Al-Torbak","year":"2005","journal-title":"Cornea"},{"key":"R10-20260424","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1097\/ICO.0000000000000890","article-title":"Late stromal rejection in deep anterior lamellar keratoplasty: A case series","volume":"35","author":"Roberts","year":"2016","journal-title":"Cornea"},{"key":"R11-20260424","article-title":"Incidence and clinical features of immunologic rejection after deep anterior lamellar keratoplasty","author":"Kasamatsu","year":"2023","journal-title":"Cornea"},{"key":"R12-20260424","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s10792-019-01164-y","article-title":"Thirty years of eye bank experience at a single centre in India","volume":"40","author":"Chaurasia","year":"2019","journal-title":"Int Ophthalmol"},{"key":"R13-20260424","doi-asserted-by":"crossref","first-page":"3166","DOI":"10.4103\/IJO.IJO_2636_22","article-title":"Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India","volume":"71","author":"Kaur","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"R14-20260424","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1097\/ICO.0000000000001666","article-title":"Etiology of global corneal blindness and current practices of corneal transplantation: A focused review","volume":"37","author":"Mathews","year":"2018","journal-title":"Cornea"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3344_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:52:20Z","timestamp":1786647140000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_3344_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,11]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_3344_23","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,11]]},"assertion":[{"value":"2023-12-26","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-14","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}