Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation

Hos, Deniz; Matthaei, Mario; Bock, Felix; Maruyama, Kouichi; Notara, Maria; Clahsen, Thomas; Hou, Yayi; Le, Viet Nhat Hung; Salabarria, Ann‐Charlott; Horstmann, Jochen; Bachmann, Björn; Cursiefen, Claus

doi:10.1016/j.preteyeres.2019.07.001

Cited by 214 publications

(217 citation statements)

References 411 publications

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Section: Resultsmentioning

confidence: 99%

“…The rate of graft rejection after DSAEK is significantly lower than that after PKP [ 4 , 8 ]. This is explained by the lower number of sutures, the absence of graft exposure to ocular-surface antigen-presenting cells, the lack of contact with stromal blood vessels, and the fact that DSAEK involves less immunogenic donor tissue than PKP [ 8 , 9 ]. In a study performed by Basak et al, two-thirds of patients who experienced graft rejection in a period between 1 and 3 years after surgery complained of blurred vision and photophobia, while the other one-third presented graft rejection that was discovered incidentally during a routine follow-up clinical evaluation.…”

Section: Resultsmentioning

confidence: 99%

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An endothelial rejection line following Descemet stripping automated endothelial keratoplasty

et al. 2020

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Background: The endothelial rejection line is rarely seen after Descemet stripping automated endothelial keratoplasties (DSAEKs). Here, we present a case of endothelial graft rejection with an endothelial rejection line occurring 1 year after the procedure. Case presentation: A 58-year-old female presented with graft rejection 1 year following a DSAEK procedure. The episode started when she tapered down her loteprednol to once a day. Slit-lamp examination showed a mildly injected conjunctiva with 1+ corneal oedema. On the posterior surface of the cornea, there was an endothelial rejection line (Khodadoust line) with keratic precipitates and multiple areas of anterior synechia. Conclusion: The classic endothelial rejection line should be kept in mind as a rare sign of DSAEK graft rejection.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

An endothelial rejection line following Descemet stripping automated endothelial keratoplasty

et al. 2020

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“…In addition to CS, topical cyclosporine A (CsA) 2% ( Belin et al, 1989 ; Inoue et al, 2000 ) or tacrolimus 0.03% ( Dhaliwal et al, 2008 ; Magalhaes et al, 2013 ) are reported to be effective in high-risk keratoplasty as a selective T cell inhibitor. Regarding a systemic immunosuppressive regimen, CSs represents the key medication ( Abud et al, 2017 ; Di Zazzo et al, 2017 ; Hos et al, 2019 ) and CsA has long been used to prevent rejection in high-risk corneal allotransplantation. However, there has been no consensus on its efficacy ( Hill, 1994 ; Shimazaki et al, 2011 ).…”

Section: Immunomodulating Agents In Xenotransplantationmentioning

confidence: 99%

Corneal xenotransplantation: Where are we standing?

Yoon¹,

Choi²,

Kim

2021

Progress in Retinal and Eye Research

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The search for alternatives to allotransplants is driven by the shortage of corneal donors and is demanding because of the limitations of the alternatives. Indeed, current progress in genetically engineered (GE) pigs, the introduction of gene-editing technology by clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9, and advanced immunosuppressants have made xenotransplantation a possible option for a human trial. Porcine corneal xenotransplantation is considered applicable because the eye is regarded as an immune-privileged site. Furthermore, recent non-human primate studies have shown long-term survival of porcine xenotransplants in keratoplasty. Herein, corneal immune privilege is briefly introduced, and xenogeneic reactions are compared with allogeneic reactions in corneal transplantation. This review describes the current knowledge on special issues of xenotransplantation, xenogeneic rejection mechanisms, current immunosuppressive regimens of corneal xenotransplantation, preclinical efficacy and safety data of corneal xenotransplantation, and updates of the regulatory framework to conduct a clinical trial on corneal xenotransplantation. We also discuss barriers that might prevent xenotransplantation from becoming common practice, such as ethical dilemmas, public concerns on xenotransplantation, and the possible risk of xenozoonosis. Given that the legal definition of decellularized porcine cornea (DPC) lies somewhere between a medical device and a xenotransplant, the preclinical efficacy and clinical trial data using DPC are included. The review finally provides perspectives on the current standpoint of corneal xenotransplantation in the fields of regenerative medicine.

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“…[1,2] Despite the increasing number of lamellar surgeries such as deep anterior lamellar keratoplasty (DALK), endothelial keratoplasty (EK), Descemet's stripping automated endothelial keratoplasty (DSAEK), and Descemet's membrane endothelial keratoplasty, approximately half of all keratoplasties performed are penetrating keratoplasties (PKPs). [3,4] There are negatives to PKP, such as suture-related problems (higher astigmatism or infection), transplant rejection, glaucoma (steroid-dependent), and rupture due to injury. [3] Despite these problems, [5][6][7] PKP could drastically improve the sight of patients with severe corneal disease or damage.…”

Section: Introductionmentioning

confidence: 99%

“…[3,4] There are negatives to PKP, such as suture-related problems (higher astigmatism or infection), transplant rejection, glaucoma (steroid-dependent), and rupture due to injury. [3] Despite these problems, [5][6][7] PKP could drastically improve the sight of patients with severe corneal disease or damage. [8] Simple stromal opacity and corneal oedema caused by endothelial dysfunction could be treated with DALK and EK, respectively.…”

Section: Introductionmentioning

confidence: 99%

Advantage of pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

Hayashi

Ida

Shimizu

et al. 2020

Preprint

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Background The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes. Methods In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to Mar 2017 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. Results This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and the spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively. Conclusion The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.

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Immune reactions after modern lamellar (DALK, DSAEK, DMEK) versus conventional penetrating corneal transplantation

Cited by 214 publications

References 411 publications

An endothelial rejection line following Descemet stripping automated endothelial keratoplasty

An endothelial rejection line following Descemet stripping automated endothelial keratoplasty

Corneal xenotransplantation: Where are we standing?

Advantage of pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

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