Incidence of Stromal Rejection in Deep Anterior Lamellar Keratoplasty in North Eye Center/Erbil

Background and objectives: Deep anterior lamellar keratoplasty has emerged as a preferred surgical option for corneal diseases, with its primary advantage being the preservation of endothelial cell density, thus reducing the risk of endothelial graft rejection. This study aimed to assess the incidence of stromal rejection in Deep anterior lamellar keratoplasty among patients in Erbil city, Kurdistan Region of Iraq. Methods: This retrospective cross-sectional study analyzed the incidence of stromal rejection in 477 patients who underwent deep anterior lamellar keratoplasty at the North Eye Center, Erbil, Kurdistan Region of Iraq, from March 2016 to January 2023. Of these, 28 patients developed stromal rejection. Medical records were reviewed to identify risk factors associated with stromal rejection, with diagnoses confirmed via slit lamp examination and visual acuity measurements. Data were analyzed using SPSS version 28, with significance set at p ? 0.05. Ethical approval was obtained, and patient confidentiality was maintained. Results: The incidence of stromal rejection in deep anterior lamellar keratoplasty was 5.87% among the patients. The study revealed a statistically significant association between rejection and clinical assessment, with loose sutures being a significant risk factor (p = 0.001). Specifically, 50% of the patients who experienced stromal rejection had loose sutures. Additionally, stromal neovascularization contributed to 25% of the rejection cases (p = 0.001). Treatment primarily involved antibiotics and steroids, with lubricants having no significant impact on rejection rates. Male predominance was observed among patients (72.1% male, 27.9% female), with no significant gender association with rejection (p = 0.341). Conclusion: The findings underscore the efficacy of Deep anterior lamellar keratoplasty in treating corneal disorders while highlighting the importance of vigilant postoperative care, particularly in monitoring suture integrity to prevent rejection.