Sir,

Lamellar keratoplasties have extended the range of corneal transplantation since the late 1990s. Descemet's stripping (automated) endothelial keratoplasty (DSAEK/DSEK) as well as Descemet membrane endothelial keratoplasty (DMEK) are nowadays mostly preferred over penetrating keratoplasty (PK) because of lower refractive errors and a quicker visual rehabilitation,1, 2 and notably because of a lower incidence of graft-rejection episodes compared with standard penetrating keratoplasties.3 Currently, there are only limited long-term data on rejection rates following DSAEK and DMEK. Price et al2 confirmed immunologic graft rejections as the major cause for graft failure in DSAEK and PK. The risk of immune responses following DMEK is ~15 times lower than in PK.4, 5 For this reason, we hypothesize that the graft stroma is involved in triggering immune rejections. We herein examine whether graft diameter and in particular, the graft placement within the anterior eye chamber, represent risk factors for graft rejections following DSAEK.

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