Immunological rejection

Signs - anterior uveitis - Epithelial rejection noted by elevated line of abnormal epithelium - subepithelial rejection marked by subepithelial infiltrates, remnisceint of adenoviral injection (LRachmer spots) - Stroma rejection features deeper haze - Endothelial rejection is characteristed by a linear pattern of keratic precipittes khodadoust line - stromal oedema reflects endothelial failure

Management - preservative free topical steroids are the mainstay - steroid ointment at night time High risk patients can be maintained on the highest tolerated topical dose (pred acetate 1% QID) Topical cycloplegia Topical ciclosporin Systemic pred for 1-2 weeks with tapering