Corneal Neovascularization as a Risk Factor for Graft Failure and Rejection after Keratoplasty

Bachmann, Björn; Taylor, Rod S; Cursiefen, Claus

doi:10.1016/j.ophtha.2010.01.039

Cited by 223 publications

(143 citation statements)

References 34 publications

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“…Both preexisting corneal BVs and LVs are important risk factors for immune‐mediated allograft rejection after high‐risk keratoplasty 4, 31, 38. Therefore, it is mandatory to regress preexisting corneal vessels in high‐risk eyes before transplantation, and mature BVs and LVs have become new therapeutic targets to enhance surgical success rates after corneal transplantation.…”

Section: Discussionmentioning

confidence: 99%

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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Immunologic graft rejection is the main complication after corneal transplant into pathologically prevascularized so‐called high‐risk eyes. The aim of this study was to evaluate whether ultraviolet (UV) light crosslinking can regress pathologic corneal blood and lymphatic vessels and thereby improve subsequent graft survival. Using the murine model of suture‐induced corneal neovascularization, we found that corneal crosslinking with UVA light and riboflavin regressed both preexisting blood and lymphatic vessels significantly via induction of apoptosis in vascular endothelial cells. In addition, macrophages and CD45+ cell counts were significantly reduced. Consistently, corneal crosslinking reduced keratocyte density and corneal thickness without affecting corneal nonvascular endothelial cells, iris, and lens depending on the crosslinking duration. Furthermore, using the murine model of corneal transplant, long‐term graft survival was significantly promoted (P < .05) and CD4+ CD25+FoxP3+ T regulatory cells were upregulated (P < .01) in high‐risk eyes preoperatively treated with crosslinking. Our results suggest UV light crosslinking as a novel method to regress both pathologic corneal blood and lymphatic vessels and to reduce CD45+ inflammatory cells. Furthermore, this study demonstrates for the first time that preoperative corneal crosslinking in prevascularized high‐risk eyes can significantly improve subsequent graft survival and may become a promising novel therapy in the clinic.

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Section: Discussionmentioning

confidence: 99%

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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“…22 Neovascularization also compromises the physiologic corneal immune privilege, potentially doubling the risk of allograft rejection. [23][24][25] The presence of seasonal allergic conjunctivitis, protracted clinical course of the hydrops, and development of corneal neovascularization are therefore significant negative prognostic factors for the longevity of any transplant for this child.…”

Section: Discussionmentioning

confidence: 99%

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Downie

2014

Pediatrics

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Acute corneal hydrops is a rare complication of advanced corneal ectasia. This case report describes the clinical course of a child with severe atopy and no previous ocular examination who developed bilateral, acute corneal hydrops, secondary to keratoconus, by 8 years of age. The report demonstrates the rapidity of progression in the pediatric phenotype of the disease. This case also provides an important clinical lesson in highlighting the necessity for children with atopy to be referred for comprehensive ophthalmic examination, even in the apparent absence of visual symptoms, to ensure the timely diagnosis and management of any atopy-associated ocular disease. Prompt referral is particularly essential for pediatric corneal ectasia, in which the rapidity of progression may preclude stabilizing treatments, such as corneal collagen cross-linking, and result in significant childhood visual impairment, as was the case for this child. This case demonstrates the potential for significant ocular involvement in atopic children and identifies scope to enhance current international clinical guidelines relating to the management of childhood atopy through the inclusion of ocular screening for associated disease.

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“…23 In addition in our study, patients who had experienced a rejection episode were more than twice as likely to have a failed graft at 5 years (Table 2). Rejection episodes following PK for HSV are as high as 46% during the first 2 years postoperatively 16 and subsequent graft failure following a rejection episode has previously been reported to be similar to our results.…”

Section: Discussionmentioning

confidence: 57%

Antiviral treatment following penetrating keratoplasty for herpetic keratitis

Goodfellow

Nabili

Jones

et al. 2011

Eye

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Follow-up data were available on 403 PKs. Kaplan-Meier survival estimates were used to determine graft survival for the three treatment groups: no medication, topical antiviral, and oral antiviral medication. A Cox regression model was used to investigate the combined effects of all additional factors on graft failure. The model was fitted using all pre-operative factors first and then postoperative factors including type of antiviral medication were included. Results Patients who received oral antiviral medication post-operatively had consistently better graft survival than those receiving no medication or only topical medication. Patients receiving oral antivirals were less than a third as likely to have a failed graft at 5 years compared with those on no antiviral medication (relative risk (RR) 0.3, CI: 0.2-0.7, P ¼ 0.002). Other factors that were found to influence the risk of graft failure were the presence of deep corneal vascularisation (P ¼ 0.009), PK performed for therapeutic reasons (P ¼ 0.03), large diameter grafts (P ¼ 0.04), and experiencing a rejection episode (P ¼ 0.003). Conclusion Oral antiviral treatment reduces the risk of graft failure in patients undergoing primary PK for herpetic keratitis and should be routinely used in this group of patients post-operatively unless contra-indicated.

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Corneal Neovascularization as a Risk Factor for Graft Failure and Rejection after Keratoplasty

Cited by 223 publications

References 34 publications

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old

Antiviral treatment following penetrating keratoplasty for herpetic keratitis

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