Descemet's membrane endothelial keratoplasty (DMEK) rejection following COVID-19 infection: A case report

PURPOSE: To report the first known case of Descemet's Membrane Endothelial Keratoplasty (DMEK) graft rejection following COVID19 infection. OBSERVATION: A 60-year-old woman with a history of DMEK for Fuch's dystrophy, presented with redness and vision loss in her operated eye 18 months after surgery. Further clinical history revealed systemic symptoms consistent with COVID19, which had started 3 weeks prior to the onset of ocular symptoms. Examination revealed graft rejection, despite patient compliance with maintenance topical corticosteroid therapy. Serological testing was positive for SARS-CoV-2 IgG. The patient responded well to intensive treatment with systemic, periocular and topical corticosteroids, and reversal of graft rejection was achieved. Two months later, there was a recurrence of graft rejection while on maintenance therapy with cyclosporin 2% and topical corticosteroids. The same intensive immunosuppressive treatment protocol was followed, and reversal of graft rejection was again achieved. CONCLUSION AND IMPORTANCE: We believe that COVID-19 infection was a causative factor in this patient DMEK rejection. By highlighting this case, we hope to raise awareness amongst ophthalmologists of potential graft complications following COVID19 infection.