Khodadoust Line Indicating Graft Rejection in Descemet’s Stripping Automated Endothelial Keratoplasty: A Unique Case Report

Abstract

Purpose: To highlight the rarity of the endothelial rejection line, also known as the Khodadoust line, as a manifestation following Descemet’s stripping automated endothelial keratoplasty (DSAEK). The objective is to present a meticulously detailed case, including imaging and anterior optical coherence tomography (OCT), to enhance understanding and recognition of this phenomenon. Methods: A detailed case presentation involving a 50-year-old male, 3 years post-DSAEK transplantation for endothelial damage resulting from intraocular surgeries. The patient urgently sought consultation due to vision loss while under daily fluorometholone use. Clinical examination revealed acute graft rejection characterized by corneal edema, anterior chamber reaction, and the presence of keratic precipitates forming a Khodadoust line. The management approach included the initiation of a tapered dexamethasone regimen. Results: The identified acute graft rejection, marked by the presence of a Khodadoust line, demonstrated favorable responsiveness to the initiated tapered dexamethasone regimen. Corneal OCT and imaging played crucial roles in providing detailed insights into the manifestation. Conclusions: While the endothelial rejection line (Khodadoust line) is a rare occurrence following DSAEK, this case underscores its potential association with graft rejection. The successful management outlined in this report suggests the importance of prompt recognition and appropriate anti-inflammatory intervention in such cases to achieve positive outcomes.