Graft rejection-like reactions in the early postoperative period after deep anterior lamellar keratoplasty for keratoconus: a retrospective study

Hirano, Kōji; Tanaka, Hidenori; Kato, Kumiko; Araki-Sasaki, Kaoru

doi:10.2147/opth.s178161

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…In addition, Th1 is downregulated via the Fas ligand in an anterior chamber-associated immune deviation response which leads to an immune-privileged environment [ 22 ]. However, despite this mechanism, immunological rejections do occur, with a higher rate in PK (15–18%) than in anterior lamellar (0–6%) and posterior lamellar (DSEK: 4–9% and DMEK: 1.2%) keratoplasty [ 2 , 11 , 23 – 25 ]. Still, in keratoplasty, sex or HLA matching is not performed widely.…”

Section: Discussionmentioning

confidence: 99%

Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients

Achiron

Yahalomi

Hecht

et al. 2022

Journal of Ophthalmology

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Purpose. It is controversial whether donor-recipient sex mismatch is a risk factor associated with corneal graft failure. The purpose of this study was to investigate the effect of sex mismatch on corneal graft failure in high-risk and non-high-risk patients. Design. A retrospective study. Methods. The medical charts of patients who underwent corneal transplantations by one surgeon between 2012 and 2017 were reviewed. Patients were defined as high-risk for failure if they had glaucoma, ocular surface disease, or corneal vascularization. Graft failure rates were compared using the Kaplan–Meier survival curves between sex matched and mismatched subjects and between male-to-female grafting and other patients. Results. One hundred and thirteen patients with a minimum follow-up of 18 months were included. In 62 non-high-risk patients, graft failure rates were similar between the sex mismatched and the sex matched recipients ( p = 0.645 , log-rank) and in male donor to female recipient transplantations and in the other transplantations ( p = 0.496 , log-rank). Analysis of fifty-one eyes of 51 high-risk graft recipients (mean age of 73.4 ± 12.7 years, N = 26 females) showed that graft failure rates were significantly higher in the sex mismatched than sex matched recipients ( p = 0.022 , log-rank) and in male donor to female recipient transplantations than in the other transplantations ( p = 0.002 , log-rank). Conclusions. Sex matching for every patient bares logistic difficulties; however, in patients who are at high-risk for graft failure, it may be a simple way to improve outcomes and better utilize corneal grafts.

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Section: Discussionmentioning

confidence: 99%

Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients

Achiron

Yahalomi

Hecht

et al. 2022

Journal of Ophthalmology

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“…Previous studies have reported various severities of suture-related complications and graft rejection-like reactions, including suture infiltration and loosening in keratoconus eyes, after keratoplasty [ 16 , 17 ]. Keratoconus eyes with post-PK episodes of VKC reactivation further increased the rate and severity of suture-related problems, such as suture abscess and suture-tract vascularization [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report

et al. 2022

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Background Keratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts. Case presentation We report the case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively. Conclusions Large-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.

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“…Apart from the National Transplantation Registry, currently there is a limited information about indications and outcomes of cor-neal transplantation in Bulgaria. Mostly the outcome measures are based on the graft rejection, which is an important issue but has limited value for evaluation of quality of vision and life of the entire population with ocular transplantation (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Transplantation in ophthalmology—single-center perspectives

Grupchev

Barbukova

2021

SSM

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INTRODUCTION: Corneal and amniotic membrane transplantations are the most frequently performed transplantations in the world. Amniotic membrane transplantation demonstrates very high efficiency in the management of the ocular surface damaged by disease or trauma. AIM: The goal of the current study is to prospectively follow and analyze the tendency in ocular transplantation in a single center in Bulgaria. MATERIALS AND METHODS: A group of 206 patients were recruited in total for a period of three years. Of them 28 had corneal transplantation and 158 had amniotic membrane transplantation. Corneal transplant patients were pre-registered on the waiting list and operated as emergency cases due to the short period of time in which the corneal material preserves best quality. Patients for amniotic membrane were planned in general, but 1/3 were operated as a matter of emergency (102 planned and 56 urgent). The procedures were performed following the standard protocols. RESULTS:The results outline the role of amniotic membrane as a follow-up treatment in 1/3 of the cases. After emergency transplantation of amniotic membrane, 12 cases underwent re-operation-corneal transplantation, and 11 received a planned second amniotic membrane transplant. These findings also highlight the main advantage of amniotic membrane-absence of graft rejection and possibility for unlimited regrafting. Another highlight is the larger number of corneal dystrophies, which underscores the benefits of amniotic membrane transplantation not only for comfort but also for visual improvement. CONCLUSION: In conclusion, amniotic membrane transplantation in Bulgaria follows the international standards, however, corneal transplantation requires revision including the legal regulations, eye bank protocols, and end-user approaches. In the future, tissue engineering will contribute to the provision of more tissue and facilitation of complicated restauration surgeries of the damaged ocular surface.

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Graft rejection-like reactions in the early postoperative period after deep anterior lamellar keratoplasty for keratoconus: a retrospective study

Cited by 6 publications

References 30 publications

Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients

Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients

Treating refractory corneal hydrops in a male patient with vernal keratoconjunctivitis and mental retardation: a case report

Transplantation in ophthalmology—single-center perspectives

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