Eleiwa TK, Cook JC, Elsawy AS, et al. - Researchers performed a cross-sectional study including 81 eyes (32 clear grafts and 17 with active rejection, along with 32 age-matched control eyes) in order to determine the performance of 3-dimensional (3D) endothelium/Descemet membrane complex thickness (En/DMT) maps vs total corneal thickness (TCT) maps in the diagnosis of active corneal graft rejection. The eyes were imaged using high-definition optical coherence tomography and using a custom-built segmentation algorithm, 3D color-coded maps of TCT and En/DMT of the central 6-mm cornea were generated. Relative to healthy corneas and clear grafts, actively rejecting grafts had significantly greater both regional TCT and En/DMT. Actively rejecting grafts were diagnosed with 100% sensitivity and 100% specificity with central, paracentral, and peripheral En/DMT (optimal cut-off value [OCV] of 19 μm, 24 μm, and 26 μm, respectively), while only 82% sensitivity and 96% specificity were achieved with central TCT (OCV of 587 μm) when 3D thickness maps were used. Moreover, they identified significant correlation of central, paracentral, and peripheral En/DMT with graft rejection severity. These findings support the utility of 3D En/DMT maps in diagnosing active corneal graft rejection with excellent accuracy, sensitivity, and specificity.