Abstract

Retrospective chart review

To report incidence and clinical course of graft rejection (GrR) in DMEK during COVID-19 vs pre-COVID years.

EMR data of consecutive 1200 DMEK analyzed. GrR during Apr’20 to Dec’22 (Gr-A) compared with GrR during Apr’16 to Dec’20 (Gr-B) with minimum 3 months follow-up. Incidence, predisposing factors, COVID-related issues, clinical outcome, and regraft were noted.

1090 eyes met the criteria. Rejection in Gr-A and Gr-B = 42/502 (8.4%) and 9/588 (1.5%) (p<0.01). Steroid drops stopped by 37 patients in Gr-A & 6 in Gr-B (p<0.01). COVID infection, vaccination history was present in 27(64.3%) patients in Gr-A. Frequent topical steroid could revert rejection episode in 32 eyes in Gr-A & 6 eyes in Gr-B. Graft failed in 10(23.8%) eyes in Gr-A & 2 eyes in Gr-B(22.2%) requiring regraft.

Graft rejection following DMEK is higher during COVID-years. COVID infection, non-access to steroid drop and vaccination may have direct or indirect effect on graft rejection.