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. 2023 Feb 14;13:2635. doi: 10.1038/s41598-023-29659-w

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© The Author(s) 2023

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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Representative slit-lamp photos of graft rejection after keratoplasty. (a) Graft rejection after PK for keratoconus in an 18-year-old male patient. The patient had been treated with 0.1% betamethasone eyedrop at the onset of rejection. Endothelial rejection with decreased visual acuity, conjunctival hyperemia, corneal edema, and keratic precipitates were observed 214 days postoperatively. Additionally, despite topical and oral steroid therapy, the graft failed. (b) Graft rejection after DSAEK for bullous keratopathy due to trabeclectomy in a 67-year-old male patient. Endothelial rejection with decreased visual acuity, conjunctival hyperemia, and keratic precipitates with pigments were observed after 164 days postoperatively. He discontinued 0.1% fluorometholone eye drop one month before. The rejection was cured with steroid eyedrop after one month. (c) Graft rejection after nDSAEK for PBK in a 75-year-old female patient. Despite betamethasone eye drops treatment after surgery, rejection occurred on day 138 postoperatively. The patient had decreased vision, corneal edema, and keratic precipitates, rather than conjunctival hyperemia. Topical and oral steroid treatment improved corneal clarity and rejection reaction after 3 weeks. (d) Graft rejection after DMEK for bullous keratopathy due to argon laser iridotomy in a 62-year-old female patient. Endothelial rejection with decreased visual acuity, conjunctival hyperemia, and keratic precipitates with pigments were observed 2031 days postoperatively. She used 0.1% fluorometholone eye drop at the time of rejection. The rejection was cured with a steroid eyedrop after one month. DMEK descemet membrane endothelial keratoplasty, DSAEK descemet’s stripping automated endothelial keratoplasty, nDSAEK non-Descemet’s stripping automated endothelial keratoplasty, PK penetrating keratoplasty, PBK pseudophakic bullous keratopathy.