A patient who underwent penetrating keratoplasty 18 months ago presents with sudden decreased vision, corneal edema, and anterior chamber inflammation. Slit-lamp reveals keratic precipitates on the graft endothelium, an endothelial rejection line (Khodadous line), and stromal edema without neovascularization. What type of graft rejection is this?

• A Epithelial rejection
• B Subepithelial rejection (Krachmer spots)
• C Chronic rejection ( endothelial decompensation)
• D Endothelial rejection ✓

Explanation

Endothelial rejection presents with keratic precipitates, an endothelial rejection line (Khodadous line) migrating across the graft, and stromal edema. It is the most common and vision-threatening rejection pattern. Epithelial rejection shows an elevated rejection line under epithelium. Subepithelial rejection shows Krachmer spots. Chronic endothelial failure presents without active inflammation.

Reference: AAO BCSC Section 8: External Disease and Cornea, 2022-2023 ed.

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Written and medically reviewed by the StethoPrep medical team.