A patient with a corneal transplant (penetrating keratoplasty) develops acute graft rejection 6 months post-operatively. The EARLIEST and MOST PATHOGNOMONIC sign of immune graft rejection is:

• A Diffuse stromal oedema throughout the donor button
• B Sub-epithelial Krachmer's spots (nummular infiltrates)
• C Khodadoust line — an endothelial rejection line of inflammatory cells crossing the donor cornea ✓
• D Deep stromal vascularisation of the graft

Explanation

The Khodadoust line (endothelial rejection line) is pathognomonic of endothelial graft rejection — the most common and sight-threatening form of corneal graft rejection. It represents a line of activated T lymphocytes advancing across the donor endothelium from the limbus towards the centre. Sub-epithelial Krachmer spots (nummular infiltrates) indicate epithelial/sub-epithelial rejection. Stromal oedema follows endothelial failure and is a late sign. Deep stromal vascularisation is a risk factor for rejection, not a sign of it.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.