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high risk cornea graft

Gustavo S Figueiredo, Borja Salvador-Culla, Oliver J Baylis, Hardeep S Mudhar, Majlinda Lako, Francisco C Figueiredo
PURPOSE: To investigate the outcomes of penetrating keratoplasty (PKP) following autologous cultivated limbal epithelial stem cell transplantation (CLET). METHODS: A prospective, single centre, interventional cohort study investigating patients with unilateral total limbal stem cell deficiency (LSCD) treated with CLET who underwent PKP. Patients with confirmed corneal re-epithelialization > 6 months post-CLET, and with best-corrected visual acuity (BCVA) <0...
February 13, 2018: Stem Cells
M Mirazul Islam, Oleksiy Buznyk, Jagadesh C Reddy, Nataliya Pasyechnikova, Emilio I Alarcon, Sally Hayes, Philip Lewis, Per Fagerholm, Chaoliang He, Stanislav Iakymenko, Wenguang Liu, Keith M Meek, Virender S Sangwan, May Griffith
The severe worldwide shortage of donor organs, and severe pathologies placing patients at high risk for rejecting conventional cornea transplantation, have left many corneal blind patients untreated. Following successful pre-clinical evaluation in mini-pigs, we tested a biomaterials-enabled pro-regeneration strategy to restore corneal integrity in an open-label observational study of six patients. Cell-free corneal implants comprising recombinant human collagen and phosphorylcholine were grafted by anterior lamellar keratoplasty into corneas of unilaterally blind patients diagnosed at high-risk for rejecting donor allografts...
2018: NPJ Regenerative Medicine
Kai B Kang, Faris I Karas, Ruju Rai, Joelle A Hallak, Joann J Kang, Jose de la Cruz, Maria S Cortina
Despite improved retention and reduced complication rates paving the way for the current expansion of applications and surge in prevalence for the Boston type I Keratoprosthesis (KPro), the most frequent indication for its implantation today remains prior graft failure. The purpose of this study is to evaluate the long-term outcomes of primary KPro and compare to secondary implantation in a matched cohort study. This study included patients who underwent KPro implantation in a single center by two surgeons between July 2008 and October 2014...
2018: PloS One
Naghmeh Fouladi, Maria Parker, Vicky Kennedy, Katie Binley, Laura McCloskey, Julie Loader, Michelle Kelleher, Kyriacos Mitrophanous, Jt Timothy Stout, Scott Ellis
Due to both the avascularity of the cornea and the relatively immune-privileged status of the eye corneal transplantation is one of the most successful clinical transplant procedures. However in high risk patients, which account for >20% of the 180,000 transplants carried out worldwide each year, the rejection rate is high due to vascularisation of the recipient cornea. The main reason for graft failure is irreversible immunological rejection and it is therefore unsurprising that neovascularisation (both pre- and post-grafting) is a significant risk factor for subsequent graft failure...
January 23, 2018: Human Gene Therapy
Maryam Tahvildari, Afsaneh Amouzegar, William Foulsham, Reza Dana
The cornea is the most commonly transplanted tissue in the body. Corneal grafts in low-risk recipients enjoy high success rates, yet over 50% of high-risk grafts (with inflamed and vascularized host beds) are rejected. As our understanding of the cellular and molecular pathways that mediate rejection has deepened, a number of novel therapeutic strategies have been unveiled. This manuscript reviews therapeutic approaches to promote corneal transplant survival through targeting (1) corneal lymphangiogenesis and hemangiogenesis, (2) antigen presenting cells, (3) effector and regulatory T cells, and (4) mesenchymal stem cells...
January 6, 2018: Cellular and Molecular Life Sciences: CMLS
Sayena Jabbehdari, Alireza Baradaran Rafii, Ghasem Yazdanpanah, Pedram Hamrah, Edward J Holland, Ali R Djalilian
PURPOSE OF REVIEW: In this article, we review the indications and latest management of high-risk penetrating keratoplasty. RECENT FINDINGS: Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts...
March 2017: Current Ophthalmology Reports
Felix Bock, Claus Cursiefen
Corneal transplantation (keratoplasty) is the most frequently performed form of transplantation worldwide. A rejection reaction against the transplant is the main complication occurring after transplantation in an already vascularized, so-called "high-risk" recipient eye. Our group has shown that clinically invisible lymphatic vessels play a crucial role in the induction of a rejection reaction against the corneal graft, and that anti-(lymph)angiogenic therapies in the mouse model of keratoplasty can significantly improve transplant survival...
May 2017: Klinische Monatsblätter Für Augenheilkunde
Maryam Tahvildari, Parisa Emami-Naeini, Masahiro Omoto, Alireza Mashaghi, Sunil K Chauhan, Reza Dana
Antigen-presenting cells (APCs) play an important role in transplant rejection and tolerance. In high-risk corneal transplantation, where the graft bed is inflamed and vascularized, immature APCs in the donor corneal stroma quickly mature and migrate to lymphoid tissues to sensitize host T cells. In this study, using a mouse model of corneal transplantation, we investigated whether enrichment of tolerogenic APCs (tolAPCs) in donor corneas can enhance graft survival in corneal allograft recipients with inflamed graft beds...
April 20, 2017: Scientific Reports
Rebecca Kaye, Bernhard Steger, Jern Y Chen, Vito Romano
PURPOSE: To describe the management of a serious adverse event in a patient undergoing penetrating keratoplasty (PK). CASE REPORT: A 68-year-old man underwent PK for an aphakic bullous keratopathy following previous complicated cataract surgery. He had no past history of herpetic disease. Storage of the corneoscleral disc in the transport bottle precluded microscopic examination. After placement of the trephined donor cornea on the open eye of the recipient, a large dendritiform geographic ulcer was noted on the donor cornea...
2017: Spektrum der Augenheilkunde: Zeitschrift der Österreichischen Ophthalmologischen Gesellschaft, ÖOG
Tulio B Abud, Antonio Di Zazzo, Ahmad Kheirkhah, Reza Dana
The cornea is the most commonly transplanted tissue in the body. Although corneal grafts generally have high success rates, transplantation onto inflamed and vascularized host beds, or so-called high-risk corneal transplantation, has a high rate of graft rejection. The management of this high-risk corneal transplantation is challenging and involves numerous measures. One of the key measures to prevent graft rejection in these cases is the use of systemic immunosuppressive agents. In this article, we will review the systemic immunosuppressive agents most commonly used for high-risk corneal transplantation, which include corticosteroids, cysclosporine A, tacrolimus, mycophenolate mofetil, and rapamycin...
January 2017: Journal of Ophthalmic & Vision Research
Takenori Inomata, Alireza Mashaghi, Antonio Di Zazzo, Sang-Mok Lee, Homer Chiang, Reza Dana
PURPOSE: To delineate and compare the kinetics of corneal angiogenesis after high-risk (HR) versus low-risk (LR) corneal transplantation. METHODS: In mice, intrastromal sutures were placed in the recipient graft bed 2 weeks before allogeneic transplantation to induce angiogenesis and amplify the risk of graft rejection. Control (LR) graft recipients did not undergo suture placement, and thus the host bed remained avascular at the time of transplantation. Graft hemangiogenesis and opacity scores were evaluated for 8 weeks by slit-lamp biomicroscopy...
April 2017: Cornea
Antonio Di Zazzo, Ahmad Kheirkhah, Tulio B Abud, Sunali Goyal, Reza Dana
The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered; however, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents...
November 2017: Survey of Ophthalmology
Vito Romano, Mario Cruciani, Luigi Conti, Luigi Fontana
BACKGROUND: Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Currently the best surgical option in terms of recurrence is conjunctival autograft. To date the most common surgical methods of attaching conjunctival autografts to the sclera are through suturing or fibrin glue...
December 2, 2016: Cochrane Database of Systematic Reviews
Jesse M Vislisel, Kenneth M Goins, Michael D Wagoner, Gregory A Schmidt, Benjamin T Aldrich, Jessica M Skeie, Cynthia R Reed, M Bridget Zimmerman, Mark A Greiner
PURPOSE: To determine the incidence of positive corneoscleral donor rim fungal cultures after keratoplasty and to report clinical outcomes of grafts with culture-positive donor rims. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutive donor corneas and keratoplasty recipients at a single tertiary referral center over 20 years. METHODS: Patient charts were reviewed to determine the incidence of positive donor rim fungal cultures and clinical outcomes of all grafts using contaminated tissue...
January 2017: Ophthalmology
Antonio Di Zazzo, Maryam Tahvildari, Brinda Subbarayal, Jia Yin, Thomas H Dohlman, Takenori Inomata, Alireza Mashaghi, Sunil K Chauhan, Reza Dana
BACKGROUND: Corneal neovascularization increases the risk of T cell-mediated allograft rejection. Here, we investigate whether T cells promote angiogenesis in transplantation. METHODS: Conventional effector T cells were collected from draining lymph nodes of allogeneic or syngeneic corneal transplanted BALB/c mice. T cells were either cocultured with vascular endothelial cells (VECs) to assess VEC proliferation or used in a mixed lymphocyte reaction assay. Messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF)-A, -C, and VEGF receptor 2 (VEGF-R2) in VECs was assessed by real-time PCR...
April 2017: Transplantation
D Pahor, A Pahor
Purpose: To present the surgical management of perforated corneal ulcer using PRECLUDE® Pericardial Membrane, composed of expanded polytetrafluoroethylene (e-PTFE; GORE-TEX®), as an alternative surgical procedure in patients at high risk of graft rejections and to evaluate side effects for a prolonged period. Patients and Methods: The study included all patients who were admitted to our department and underwent surgical repair of perforated corneal ulcer with the e-PTFE membrane between 2010 and 2015. In total, 8 patients (8 eyes) were enrolled...
October 2016: Klinische Monatsblätter Für Augenheilkunde
Jeanie D Ling, Viraj Mehta, Cherie Fathy, Yuna Rapoport, Matthew M Zhang, Anthony Daniels, Sahar Kohanim
Corneal transplantation is a common type of tissue transplantation that aims to improve vision or relieve pain. Given the immune privilege of the cornea, the primary graft often has a high success rate, approaching 90%. Despite the good overall outcome of corneal transplantation in various studies, the individual graft survival rate varies, depending on the preoperative diagnosis and donor and recipient factors. Race and ethnicity have been shown to be important in other types of organ transplantation. The aim of this study was to review the available ophthalmic literature regarding any differences in rates and outcomes of corneal transplantation based on ethnicity and race...
2016: Seminars in Ophthalmology
Lucia Kuffova, Jared E Knickelbein, Tian Yu, Carlos Medina, Guillermo Amescua, Alexander M Rowe, Robert L Hendricks, John V Forrester
PURPOSE: The "high-risk phenotype" of corneal graft recipients is considered to be related to preexisting vascularization such as that associated with herpes simplex virus-1 (HSV-1) keratitis (HSK). The purpose of this study was to investigate the immunologic mechanisms underlying accelerated corneal graft rejection using a mouse model of HSK. METHODS: Herpes simplex virus type 1 keratitis was induced in BALB/c mice. Syngeneic and allogeneic (C57BL/6 mice) corneal grafts were performed in mice with HSK at different times after infection...
April 2016: Investigative Ophthalmology & Visual Science
Tian Yu, Vijayalakshmi Rajendran, May Griffith, John V Forrester, Lucia Kuffová
Corneal transplantation is the most common surgical procedure amongst solid organ transplants with a high survival rate of 86% at 1-year post-grafting. This high success rate has been attributed to the immune privilege of the eye. However, mechanisms originally thought to promote immune privilege, such as the lack of antigen presenting cells and vessels in the cornea, are challenged by recent studies. Nevertheless, the immunological and physiological features of the cornea promoting a relatively weak alloimmune response is likely responsible for the high survival rate in "low-risk" settings...
March 24, 2016: World Journal of Transplantation
Shveta Bali, Richard Filek, Francie Si, William Hodge
Cornea transplantation has a high success rate and typically only requires topical immunomodulation. However, in high-risk cases, systemic immunosuppression can be used. We conducted a systematic review on the efficacy and side effects of systemic immunosuppression for high-risk cornea transplantation. The study population was 18 years old or older with a high-risk transplant (two or more clock hours of cornea vascularization or a previous failed graft or a graft needed because of herpes simplex keratitis)...
April 2016: Journal of Clinical Medicine Research
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