PURPOSE To describe a case of stromal rejection in a 46-year-old man after small incision lenticule extraction (SMILE) for the correction of residual astigmatism following deep anterior lamellar keratoplasty (DALK). METHODS Case report. RESULTS Nine years after an uneventful DALK in the left eye, the patient (uncorrected distance visual acuity [UDVA] = 20/200, corrected distance visual acuity [CDVA] = 20/32, and refraction = -3.25 -4.25 × 165°) underwent SMILE using the VisuMax femtosecond laser platform (Carl Zeiss Meditec, Jena, Germany). The next day, the UDVA, CDVA, and refraction were 20/40, 20/32, and -1.25 -0.50 × 15°, respectively. One week later, the patient presented complaining of pain, photophobia, and blurred vision; at this time, there was a reduction in UDVA to 20/400 and CDVA to 20/63. With a diagnosis of stromal rejection, the patient was treated with corticosteroids (sub-Tenon injection and oral). Five months later, UDVA was 20/40, CDVA was 20/25, and refraction was -1.25 -0.75 × 90°. The graft had completely cleared. CONCLUSIONS SMILE can be an effective alternative for the correction of astigmatism after DALK, but the risks of inflammatory responses and graft rejection call for caution. [J Refract Surg. 2019;35(11):737-739.].

中文翻译：

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SMILE后的间质排斥，用于矫正移植后的散光。

目的描述一例46岁男性小切口小孔镜摘除术（SMILE）后的基质排斥反应，以纠正深层前板角膜成形术（DALK）后的残余散光。方法病例报告。结果左眼DALK正常后九年，患者（未矫正的远视力[UDVA] = 20/200，矫正的远视力[CDVA] = 20/32和屈光度= -3.25 -4.25×165°）使用VisuMax飞秒激光平台（Carl Zeiss Meditec，德国耶拿）进行了SMILE。第二天，UDVA，CDVA和折射分别为20 / 40、20 / 32和-1.25 -0.50×15°。一周后，患者出现疼痛，畏光和视力模糊的症状。此时，UDVA减少到20/400，CDVA减少到20/63。诊断为基质排斥 该患者接受皮质类固醇激素治疗（Tenon注射和口服）。5个月后，UDVA为20/40，CDVA为20/25，折射为-1.25 -0.75×90°。移植物已完全清除。结论SMILE可以作为DALK术后散光矫正的有效替代方法，但是炎症反应和移植物排斥反应的风险值得谨慎。[J Refract Surg。2019; 35（11）：737-739。]。