A 45-year-old patient undergoes penetrating keratoplasty for keratoconus. Three weeks postoperatively, a line of keratic precipitates is seen confined to the donor endothelium with overlying stromal edema and anterior chamber cells. No involvement of the host cornea is noted. What type of graft rejection is this?

• A Epithelial rejection
• B Subepithelial (Khodadoust) rejection
• C Stromal rejection
• D Endothelial rejection (Khodadoust line) ✓

Explanation

Endothelial rejection presents as the Khodadoust line, a linear arrangement of keratic precipitates on the donor endothelial surface progressing from periphery to center, with corneal edema and AC cells. It is the most common and clinically significant form of rejection. Subepithelial rejection shows nodules at the graft-host junction. Epithelial rejection shows an elevated rejection line on the epithelial surface. Stromal rejection is rare and nonspecific.

Reference: AAO BCSC Section 8: External Disease and Cornea, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.