Despite considerable surgeon experience and care exercised while performing the descemetorhexis, some roughening of the posterior stroma seemed to impede repopulation by host endothelial cells in a localized area and led to chronic corneal inflammation when a graft was not implanted. The prolonged corneal edema and associated symptoms resulted in a less desirable postoperative course compared with the rapid corneal clearing regularly achieved with Descemet membrane endothelial keratoplasty.

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This study demonstrates the substantial rate of rejection episodes that can be induced by corneal stroma in DALK and suggests that postoperative topical corticosteroids should be continued longer than the study's 7-week median and that young African Americans need higher-dose, longer-duration topical corticosteroids. The association between the side-cut method and rejection risk merits further investigation.