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Corneal graft rejection

Giuseppe Giannaccare, Jayne S Weiss, Laura Sapigni, Cristina Bovone, Leila Mattioli, Emilio C Campos, Massimo Busin
PURPOSE: To evaluate the rate and outcomes of immunologic stromal rejection occurring after large deep anterior lamellar keratoplasty (DALK) and the effect of the underlying disease on the cumulative probability of rejection. METHODS: This was a retrospective chart review of all eyes that underwent a 9-mm DALK at Ospedali Privati Forlì (Forlì, Italy). On the basis of preoperative diagnosis, eyes were assigned to group 1: keratoconus, group 2: stromal disease with a low risk for rejection, or group 3: stromal disease with a high risk for rejection...
March 14, 2018: Cornea
Fatema Asi, Georgia Milioti, Berthold Seitz
We report a case of corneal decompensation caused by recurrent herpetic endotheliitis that was treated successfully with Descemet membrane endothelial keratoplasty (DMEK). A 62-year-old woman presented with a history of recurrent herpetic infections in the right cornea. After topical and systemic treatment with antivirals and steroids for 5 months, DMEK combined with cataract surgery was performed. Two weeks after DMEK, the corrected distance visual acuity (CDVA) in the affected eye was 0.3 (20/60). One year postoperatively, the CDVA was 1...
January 2018: Journal of Cataract and Refractive Surgery
Qun Wang, Chao Wei, Li Ma, Xin Wang, Lin Li, Qingjun Zhou, Weiyun Shi
PURPOSE: Endothelial dysfunction accounts for 50% of total corneal transplantation failures, suggesting that corneal endothelial damage is the leading cause of graft failure. Tumor necrosis factor-α (TNF-α) is known to contribute to the negative regulation of corneal transplantation, but how it does so remains unclear. Here, we report a regulatory loop involving TNF-α, TNF-α-induced protein 8 like 2 (TNFAIP8L2 or TIPE2), and apoptosis during corneal graft rejection. METHODS: We established mice models of penetrating keratoplasty to verify whether the quantification of TNF-α in allogeneic corneas is enhanced through ELISA assay and immunofluorescence staining...
February 26, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Jorge L Alió Del Barrio, Alfredo Vega-Estrada, Jorge L Alió
PURPOSE: To describe an alternative treatment option for secondary Descemet membrane endothelial keratoplasty (DMEK) graft failure, using a second DMEK graft without primary graft removal ("DMEK under DMEK"). METHODS: A 72-year-old patient with pseudophakic bullous keratopathy in the left eye underwent an 8.25-mm second DMEK under an 8.5-mm failed DMEK because of previous graft rejection and subsequent secondary failure. RESULTS: Corrected distance visual acuity improved from 0...
February 22, 2018: Cornea
Emmanuel Crouzet, Thibaud Garcin, Anne-Sophie Gauthier, Zhiguo He, Chantal Perrache, Xavier Delavenne, Thierry Basset, Michel Peoc'h, Philippe Gain, Gilles Thuret
AIMS: To evaluate the efficacy of a subconjunctival dexamethasone-releasing implant in preventing rejection of penetrating keratoplasty (PK) in an animal model. METHODS: Twenty-two rabbits underwent allogenic PK. After randomisation, they received either a 700 µg dexamethasone implant under the conjunctiva at the end of surgery (n=10), one dexamethasone 1 mg/mL eye-drop thrice daily (n=6) or a placebo thrice daily (n=6). The suture was left in place. Animals were observed weekly by slit-lamp and optical coherence tomography with quantification of transparency, neovascularisation and central corneal thickness (CCT)...
February 3, 2018: British Journal of Ophthalmology
S X Li, J T Wang, Y Jiang, X Wang, W Y Shi
Objective: To evaluate the efficacy of modified deep lamellar keratoplasty (DLKP) combined with antiviral medications for severe herpes necrotizing stromal keratitis. Methods: Retrospective case series study. Modified DLKP was performed in combination with antiviral medications in fifty patients (50 eyes) with severe necrotizing stromal keratitis, which was unresponsive to systemic and topical antiviral treatment for 1 week, at Shandong Eye Hospital. Before surgery, the operated eyes were examined using slit-lamp microscopy...
February 11, 2018: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
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
Abdulrahman Khairallah
BACKGROUND: Failed corneal graft management is a challenge. Descemet stripping automated endothe.lial keratoplasty (DSAEK) and repeat penetrating keratoplasty (PKP) are two options. Only two studies have compared outcomes of DSAEK and PKP in the management of a failed graft. OBJECTIVE: To compare the visual outcomes, changes in intraocular pressure (IOP) and complications in eyes with failed corneal grafts that were subsequently managed with DSAEK and PKP. DESIGN: Retrospective cohort study...
January 2018: Annals of Saudi Medicine
Miao He, He Jin, Hong He, Hui Ding, Wei Wang, Liangping Liu, Chi Zhang, Xingwu Zhong
PURPOSE: To evaluate the feasibility and safety of xenogeneic endokeratophakia in rhesus monkeys and to explore the effects of a concave lenticule on refractive power. METHODS: Three adult New Zealand white rabbits and 6 healthy rhesus monkeys were used. The xenogenic concave grafts were created from the rabbits using a modified small incision lenticule extraction technique; after being cryopreserved in glycerol for 1 week, the grafts were implanted into the monkey recipient corneas...
March 2018: Cornea
Yu Qiang Soh, Jodhbir S Mehta
PURPOSE: Fuchs endothelial corneal dystrophy (FECD) is an acquired corneal endotheliopathy and is one of the most common indications for corneal transplantation surgery worldwide. Endothelial keratoplasty (EK) is the most popular form of corneal transplantation for FECD. In standard EK surgery, the patient's corneal endothelium and basement membrane [ie, Descemet membrane (DM)] are first removed, followed by transplantation of donor tissue that comprises allogenic corneal endothelial cells, DM, and corneal stroma of variable thickness...
April 2018: Cornea
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
S W Li, C Liu, T H Chen, J H Ning, T Zhang, F J Lyu, M Xu
Objective: To report the clinical results of pediatric penetrating keratoplasty (PKP) in patients under 3 years old with congenital corneal opacity. Methods: Retrospective study. Sixteen eyes of 12 patients who were treated with PKP in Aier Eye Hospital Group from June 2009 to December 2016 were enrolled in this study. All the patients were diagnosed as congenital corneal opacities: 8 cases (11 eyes) with Peter's anomaly I, 2 cases (3 eyes) with sclerocornea, and 2 cases (2 eyes) with corneal dermoid tumor combined with iris synechia...
December 11, 2017: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Koji Kitazawa, Koichi Wakimasu, Kanae Kayukawa, Manabu Sugimoto, Junko Nakai, Jayne S Weiss, Morio Ueno, Chie Sotozono, Shigeru Kinoshita
PURPOSE: To investigate the long-term surgical outcome after penetrating keratoplasty in 5 patients from 1 pedigree with Schnyder corneal dystrophy (SCD), resulting from the same UbiA prenyltransferase domain containing 1 (UBIAD1) mutation. METHODS: This retrospective study involved 6 eyes of 5 patients who underwent penetrating keratoplasty for treatment of SCD. Postoperative surgical outcome measures included the analysis of best-corrected visual acuity (BCVA), corneal endothelial cell density, and the rates of corneal graft rejection and disease recurrence...
January 9, 2018: Cornea
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
Magnus Kruse, Peter Walter, Benedict Bauer, Stephan Rütten, Karola Schaefer, Niklas Plange, Thomas Gries, Stefan Jockenhoevel, Matthias Fuest
BACKGROUND: Corneal endothelial dysfunction remains the most frequent indication for corneal transplantation, limited by donor material shortage, poor long-term graft survival, or allogeneic graft rejection. Therefore, tissue-engineered endothelial grafts (TEEG) represent a promising alternative to human donor tissue. In this study, we generated electro-spun scaffolds and tested these for their suitability for human corneal endothelial cell (hCEC) cultivation. METHODS: The polymers poly(methyl-methacrylate) (PMMA), poly(lactic-co-glycolic acid) (PLGA), and polycaprolactone (PCL) were spun with equal parameters...
January 2018: Current Eye Research
Alexandra Z Crawford, Thiyagaraj Krishnan, Susan E Ormonde, Dipika V Patel, Charles N McGhee
PURPOSE: To quantify all minor/major adverse events in a large cohort of consecutive corneal transplants, particularly in respect to penetrating keratoplasty (PKP). METHODS: All corneal transplants in the Auckland region over a 10-year period (2000-2009) were identified through the New Zealand National Eye Bank. Relevant clinical records were assessed for this period and 2 years after. All intraoperative or postoperative adverse events/complications, visual acuity, and graft outcomes were recorded...
March 2018: Cornea
Lin Li, Hualei Zhai, Lixin Xie, Jun Cheng, Weiwei Liu
PURPOSE: To evaluate the therapeutic effects of lamellar keratoplasty (LK) on Terrien marginal degeneration (TMD). METHODS: Retrospective interventional case series. Medical records of 63 patients (71 eyes) who received LK for TMD at Qingdao Eye Hospital, Shandong Eye Institute from December 1995 to March 2014 were reviewed. A total of 56 eyes were treated with partial LK and 15 eyes with total LK. Complications, visual acuity recovery, and graft status were evaluated...
March 2018: Cornea
Mi Jin Kim, Joo Hyun Kim, Hyun Sun Jeon, Won Ryang Wee, Joon Young Hyon
PURPOSE: To investigate the influence of histocompatibility Y (H-Y) antigen matching on corneal graft survival in primary penetrating keratoplasty (PK). METHODS: Medical records of patients who underwent primary PK at Seoul National University Bundang Hospital between June 2005 and October 2015 were retrospectively analyzed. The eyes were classified into 2 groups: H-Y-compatible (115 eyes) and H-Y-incompatible (23 eyes). The H-Y-compatible group included donor/recipient combinations of male/male (57 eyes), female/male (44 eyes), and female/female (14 eyes)...
January 2018: Cornea
Marcus Ang, Chelvin C A Sng
PURPOSE OF REVIEW: The aim of this review is to describe the relationship between Descemet membrane endothelial keratoplasty (DMEK) and glaucoma. RECENT FINDINGS: Glaucoma after DMEK is a serious complication that may cause permanent visual loss, affect donor endothelial cells and graft survival. The mechanisms of raised intraocular pressure (IOP) after DMEK include reverse pupillary block in the early postoperative period, and steroid response in the late phase...
March 2018: Current Opinion in Ophthalmology
Yanhong Hou, Viet Nhat Hung Le, Thomas Clahsen, Ann-Charlott Schneider, Felix Bock, Claus Cursiefen
Purpose: Pathologic corneal (lymph) angiogenesis is a known risk factor for immune-mediated allograft rejections after corneal transplantation. However, there is no established treatment to regress pre-existing pathological corneal blood and lymphatic vessels. This study assessed the possibility to regress both vessel types by photodynamic therapy (PDT) after intravenous (i.v.) verteporfin injection, the influence of timing of PDT after verteporfin injection, and the effect on graft survival in high-risk keratoplasty...
November 1, 2017: Investigative Ophthalmology & Visual Science
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