gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Hyperacute stromal allograft rejection after penetrating keratoplasty

Meeting Abstract

  • corresponding author N. Wakili - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
  • B. Seitz - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
  • H.E. Völcker - Department of Ophthalmology, University of Heidelberg, Heidelberg
  • G.O.H. Naumann - Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.09.10

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Wakili et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Endothelial corneal allograft rejection (AR) is the most frequent cause of irreversible allograft opacity. Herein, we present a rare and special form of immunologic AR, the hyperacute stromal AR.


Retrospectively, 78 of 3641 patients were detected by means of the computer-assisted automated Erlangen operation system OPERA in the period from 1990 to 2003, who received a repeat penetrating keratoplasty (PK) after AR. Thereof 4 patients showed the picture of a hyperacute stromal AR. We describe the characteristic clinical and histopathological features.


Four patients, aged 63±12 years, received a PK because of different reasons (neuroparalytic corneal ulcer, traumatic endothelial decompensation, perforated cornea-iris-lens-injury, crystalline keratopathy). Four, 12, 18 and 57 months after PK (3x first PK, 1x third PK) a hyperacute AR occurred. The course of the disease was comparable in all patients: an acute beginning within a few days, a rapid progressive course, a diffuse, whitish leucocytic infiltration strictly constricted to the allograft and an intraocular inflammation with retrocorneal infiltration, but without hypopyon. A PK à chaud was performed in each patient. Histopathologically, a necrotizing, diffuse stromal keratitis with an infiltration mainly composed of neutrophilic granulocytes was present. Neither histopathologically nor microbiologically a pathogen could be verified. After 3, 9, 9 months or 10 1/2 years, respectively, the corneal allograft remained clear.


We described the characteristic clinical and histopathological picture of a special form of stromal immunologic AR with good prognosis after PK à chaud. Its knowledge is important for differentiation against infectious processes and for the resulting therapy as well as for the estimation of prognosis.