The clinical appearance of endothelial rejection following penetrating keratoplasty was studied in three human cases. On the posterior surface of each graft was an endothelial rejection line formed by keratitic precipitates. In two cases, the rejection process was reversed with corticosteroids, while in one case, the endothelial rejection line progressed across the back of the graft, destroying the transplanted endothelium.
This latter graft became available for study five weeks after the onset of rejection. Routine histologic and scanning electron microscopic examination of this specimen showed nearly complete destruction of endothelial cells and early retrocorneal membrane formation.
The presence of an endothelial rejection line proved a common helpful sign in the diagnosis of early graft rejection.
Levenson JE, Brightbill FS. Endothelial Rejection in Human Transplants. Arch Ophthalmol. 1973;89(6):489-492. doi:10.1001/archopht.1973.01000040491009