Corneal Graft Rejection

Panda, Anita; Vanathi, Murugesan; Kumar, Adarsh; Dash, Yeshoda; Priya, Sarv

doi:10.1016/j.survophthal.2007.04.008

Cited by 258 publications

(228 citation statements)

References 161 publications

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“…O epitélio, estroma e endotélio corneanos podem sofrer rejeição de forma isolada ou associada, o que embasa a seguinte classificação (1,25) : Rejeição epitelial; Rejeição subepitelial; Rejeição estromal; Rejeição endotelial; Rejeição mista (estromal e endotelial); Rejeição em retransplantes.…”

Section: Quadro Clínico Da Rejeição De Transplantes De Córneaunclassified

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Rejeição de transplante de córnea

Costa¹,

Kara‐José²

2008

Rev. bras.oftalmol.

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RESUMOA rejeição do transplante de córnea é um processo imunológico celular de ataque a córnea transplantada que pode resultar em sua descompensação. É a causa mais comum de falência de transplantes. Os fatores de risco mais comuns para rejeição são a vascularização corneana, falência prévia por rejeição, sinéquias anteriores, botão doador grande ou descentrado, inflamação intra-ocular e cirurgias no segmento anterior. O quadro clínico é caracterizado por hiperemia, dor ocular, edema corneano e inflamação na câmara anterior. As rejeições podem ser classificadas em epitelial, subepitelial, estromal, endotelial, mista e em retransplantes. A prevenção de rejeições pode ser realizada através de técnica cirúrgica meticulosa, utilização de transplantes lamelares, histocompatibilidade receptor-doador e estratégias farmacológicas. Os corticosteróides são a terapia de escolha para o tratamento da rejeição de transplante de córnea e podem ser utilizados em diversas vias e dosagens. Os autores propõem protocolo de tratamento para rejeições. Descritores: Transplante de córnea/efeitos adversos; Rejeição de enxerto/imunologia; Rejeição de enxerto/classificação; Rejeição de enxerto/terapia; Esteróides/uso terapêutico; Revisão

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Section: Quadro Clínico Da Rejeição De Transplantes De Córneaunclassified

“…A rejeição do transplante de córnea é um processo imunológico de reação celular e humoral, uma córnea enxertada que pode resultar na descompensação da mesma (1) . Ocorre no período pós-operatório, tendo sido relatados episódios de 14 dias a 30 anos, e é a principal causa de falência das ceratoplastias (2) .…”

Section: Introductionunclassified

Rejeição de transplante de córnea

Costa¹,

Kara‐José²

2008

Rev. bras.oftalmol.

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“…The two major systemic therapeutic options are oral prednisone and an intravenous pulse of methylprednisolone. 14 In a study, Hill et al 6 found a high success rate (92.3%) using intravenous methylprednisolone when treatment was given within 8 days of the onset of symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…The rate of reversibility after an acute corneal rejection is quite variable, ranging from 50 to 94%, 1,[6][7][8][9][10][11][12] and this depends on numerous factors, including previous rejection episodes, amount of time between symptom onset and treatment, graft size, preoperative diagnosis, graft thickness at the time when rejection is diagnosed, recipient age, lens status, concomitant vitrectomy, deep stromal vascularization, and peripheral anterior synechiae, among others. 2,5,[12][13][14] The primary treatment of corneal allograft rejection is corticosteroids, which can be administered through topical, periocular, oral, and intravenous routes. The optimal route of administration remains unknown, 15 and many diverse approaches are currently employed.…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly used is prednisone, usually given daily at a dose greater than 60-80 mg for the first several days, with subsequent tapering of the dose as the graft begins to recover. 14 Some immunosuppressants also have a role in the treatment and prevention of corneal rejections. Cyclosporine, used both topically and systemically, has been the most commonly used drug in this group.…”

Section: Introductionmentioning

confidence: 99%

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Case–control study of subconjunctival triamcinolone acetonide injection vs intravenous methylprednisolone pulse in the treatment of endothelial corneal allograft rejection

Costa

Castro

Kara‐José

2008

Eye

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Purpose To assess the safety and effectiveness of treating corneal endothelial rejection with a subconjunctival injection of 20 mg triamcinolone acetonide in combination with topical application of 1% prednisolone acetate, as compared to treatment with an intravenous pulse of 500 mg methylprednisolone in combination with topical application of 1% prednisolone acetate. Methods A case-controlled study including a literature review was performed. Patients who presented with an initial episode of corneal endothelial rejection were treated with subconjunctival injection of 20 mg triamcinolone in combination with topically applied 1% prednisolone and were retrospectively matched for age and diagnosis to patients who received a single intravenous injection of 500 mg methylprednisolone in combination with topical 1% prednisolone. Patients were analysed regarding reversion of the rejection episode, intraocular pressure, and visual acuity after 1 year.

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Suppression of Inflammatory Corneal Lymphangiogenesis by Application of Topical Corticosteroids

Hos

Saban²,

Bock³

et al. 2011

Arch Ophthalmol

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Objectives:To analyze whether topical application of corticosteroids inhibits inflammatory corneal lymphangiogenesis and to study the potential underlying antilymphangiogenic mechanisms.Methods: Inflammatory corneal neovascularization was induced by suture placement, and the corneas were then treated with topical fluorometholone, prednisolone acetate, or dexamethasone sodium phosphate. After 1 week, the corneas were stained with lymphatic vessel endothelial hyaluronan receptor 1 for detection of pathological corneal lymphangiogenesis. The effect of these corticosteroids on macrophage recruitment was assessed via fluorescence-activated cell sorting analysis. The effect of these corticosteroids on proinflammatory cytokine expression by peritoneal exudate cells was tested via real-time polymerase chain reaction. Furthermore, the effect of steroid treatment on the proliferation of lymphatic endothelial cells was assessed via enzyme-linked immunosorbent assay.Results: Treatment with corticosteroids resulted in a significant reduction of inflammatory corneal lymphangiogenesis. The antilymphangiogenic effect of fluorometholone was significantly weaker than that of prednisolone and dexamethasone. Corneal macrophage recruitment was also significantly inhibited by the application of topical steroids. Treatment of peritoneal exudate cells with corticosteroids led to a significant downregulation of the RNA expression levels of tumor necrosis factor and interleukin 1␤. Additionally, proliferation of lymphatic endothelial cells was also inhibited.

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Corneal Graft Rejection

Cited by 258 publications

References 161 publications

Rejeição de transplante de córnea

Rejeição de transplante de córnea

Case–control study of subconjunctival triamcinolone acetonide injection vs intravenous methylprednisolone pulse in the treatment of endothelial corneal allograft rejection

Suppression of Inflammatory Corneal Lymphangiogenesis by Application of Topical Corticosteroids

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