Descemet's membrane endothelial
keratoplasty (DMEK) for patients with corneal endothelial loss rarely results in graft rejection. Herein, we report a rare case of graft rejection following DMEK, in which peripheral anterior synechiae were observed postoperatively. A 66-year-old woman was referred to our hospital after complaints of decreased visual acuity of her right eye after
laser iridotomy for primary angle closure 3 years earlier. Her right cornea had bullous keratopathy with mild
cataract, and her best-corrected visual acuity (BCVA) was 20/40. After
cataract surgery, DMEK was successfully performed, except for development of peripheral anterior synechiae at the temporal cornea. Her BCVA recovered to 20/20. However, when topical instillation was changed to 0.1%
fluorometholone from 0.1%
betamethasone once a day,
corneal edema reappeared with
hyperemia, mutton fat keratic precipitates (KPs), and cells in the anterior chamber. The BCVA worsened to 20/32. Graft rejection was diagnosed, and subconjunctival injection of
dexamethasone was performed 3 times, once every few days, with 0.1% topical
betamethasone instillation. Subsequently, the
hyperemia, mutton fat KPs, and cells in the anterior chamber disappeared with a recovered BCVA of 20/20 after 2 weeks. Ten months after graft rejection, there was no recurrence of intraocular
inflammation, and only topical
betamethasone was administered twice daily. It is important to exercise caution in cases with peripheral anterior synechiae after DMEK. Long-term
steroid administration is necessary to prevent graft rejection.