ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
This article is part of the Research TopicImaging in the Diagnosis and Treatment of Eye DiseasesView all 37 articles
Imaging-Based Assessment of Corneal Graft Rejection after Penetrating Keratoplasty: Insights from Confocal Microscopy and Anterior Chamber Analysis
Provisionally accepted
- Eye Center, Xiamen University, Xiamen, China
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Objective: To explore the distribution of rejection and visual changes after optical and therapeutic penetrating keratoplasty (PKP) in Southeastern China. Methods: A retrospective study was conducted on 104 patients who underwent optical or therapeutic PKP between December 2014 and April 2022 at Xiamen Eye Center. Data included demographic characteristics, primary disease, visual acuity, in vivo confocal microscopy (IVCM) findings, and postoperative outcomes. Endothelial inflammation was assessed by IVCM, and anterior chamber paracentesis was performed in patients with recurrent rejection (>2 hospitalizations) for viral and cytokine analysis. Results: Of 104 eyes (68 males, 36 females; mean age 51.9 ± 12.9 years), 42 received optical PKP and 62 therapeutic PKP. Mean host bed size was 7.81 ± 0.75 mm and graft size 8.28 ± 0.75 mm. During follow-up, 4 patients developed secondary glaucoma and 1 relapsed. Twelve patients (2 optical, 10 therapeutic) required repeat PKP and were successfully managed. Larger graft size (>7.8 mm) and therapeutic PKP were identified as significant risk factors for graft rejection, whereas conjunctival congestion, infiltration depth, and femtosecond-assisted PKP did not show any significant association with rejection. Among 40 cases with recurrent rejection, aqueous fluid analysis identified viral infection in 20% (3 VZV, 10 HSV, 7 CMV). Elevated inflammatory cytokines were found in 32 cases and were steroid-responsive, whereas 3 cases showed poor response. Conclusions: PKP effectively addresses both optical and therapeutic indications, but larger grafts and therapeutic PKP increase rejection risk. Imaging with IVCM and anterior chamber analysis provides valuable diagnostic and prognostic information, supporting individualized management of graft rejection.
Keywords: Penetrating keratoplasty, Corneal graft rejection, Primary disease, visual outcome, risk factor
Received: 01 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Lin, Liu, Li, Fang, Xie, Luo, Xiao and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yuan Lin, 547165132@qq.com
Huping Wu, wuhuping123@163.com
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