Systemic immunosuppression with mycophenolate mofetil to prevent corneal graft rejection after high risk penetrating keratoplasty: a 2-year follow-up study

AbstractTo determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet’s complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.

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Histomorphological view of the cornea investigated by laser confocal microscopy in keratoplasty

Medical Council ◽

10.21518/2079-701x-2021-21-2-110-117 ◽

2022 ◽

pp. 110-117

Author(s):

D. A. Krakhmaleva ◽

Z. V. Surnina ◽

S. A. Malzhoen ◽

A. A. Gamidov

Keyword(s):

Confocal Microscopy ◽

Immune Cells ◽

Graft Rejection ◽

Penetrating Keratoplasty ◽

Corneal Transplantation ◽

Corneal Graft ◽

Rejection Reaction ◽

Corneal Graft Rejection

Introduction. Corneal transplantation is the most successful and commonly performed allotransplantation procedure as compared with other organs and tissues. Over 100,000 corneal transplantations are performed worldwide every year.Purpose. This study investigated whether in vivo confocal microscopy (IVCM) can aid in the diagnosis of a graft rejection reaction by detecting changes in cellular structures and density of immune cells after penetrating keratoplasty.Materials and methods. The study included thirty-four eyes of 34 patients who underwent penetrating keratoplasty (7 eyes with corneal graft rejection, 27 without rejection). The average age of patients is 51.1 ± 13.6 years (from 23 to 76 years). The follow-up period ranged from 12 to 36 months (24.5 ± 4.84 months). Follow-up was performed at 1, 3, 6, 12 months and annually after PKP. To study the morphology of the cornea all patients underwent IVCM to assess the basal epithelium, subbasal layer, stroma and endothelium. Immune cells were identified and evaluated for the shape, length of the processes and their density.Results. Patients with corneal graft rejection demonstrated significant accumulation of corneal dendritic-like immune cells compared to patients with non-rejected grafts. In addition, the cells acquired a more mature morphology (grade 2–3). The density of dendritic cells (DC) was 809.17 ± 342.19 (p < 0.001). A positive correlation was found between DC density and graft rejection (p < 0.001). As well the patients showed signs of endothelial failure with low endothelial cell density and pleomorphism, increased light scattering and hyperreflectivity of the stroma.Conclusions. In a complex of diagnostic measures, confocal microscopy may provide a valuable clinical adjunctive tool in diagnosis and management of early corneal graft rejection.

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Efficacy of Amniotic Membrane Transplantation on Corneal Graft Rejection with Epithelial Defects after Penetrating Keratoplasty

Chonnam Medical Journal ◽

10.4068/cmj.2009.45.1.55 ◽

2009 ◽

Vol 45 (1) ◽

pp. 55

Author(s):

In-Seong Kang ◽

Yoon-Ha Kim ◽

Tae-Bok Song ◽

Jae-Kap Cho ◽

Yeoung-Geol Park ◽

...

Keyword(s):

Amniotic Membrane ◽

Graft Rejection ◽

Penetrating Keratoplasty ◽

Corneal Graft ◽

Amniotic Membrane Transplantation ◽

Corneal Graft Rejection

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Immunosuppressants for the prophylaxis of corneal graft rejection after penetrating keratoplasty

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd007603.pub2 ◽

2015 ◽

Cited By ~ 6

Author(s):

Minawaer Abudou ◽

Taixiang Wu ◽

Jennifer R Evans ◽

Xueyi Chen

Keyword(s):

Graft Rejection ◽

Penetrating Keratoplasty ◽

Corneal Graft ◽

Corneal Graft Rejection

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Aqueous Flare Following Penetrating Keratoplasty and in Corneal Graft Rejection

Archives of Ophthalmology ◽

10.1001/archopht.1994.01090150084028 ◽

1994 ◽

Vol 112 (3) ◽

pp. 354 ◽

Cited By ~ 22

Author(s):

Michael Küchle

Keyword(s):

Graft Rejection ◽

Penetrating Keratoplasty ◽

Corneal Graft ◽

Aqueous Flare ◽

Corneal Graft Rejection

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Postoperative therapy of penetrating keratoplasty in herpes simplex keratitis

Orvosi Hetilap ◽

10.1556/oh.2013.29791 ◽

2013 ◽

Vol 154 (52) ◽

pp. 2065-2070 ◽

Cited By ~ 1

Author(s):

Ildikó Süveges ◽

Ágnes Füst ◽

László Imre

Keyword(s):

Visual Acuity ◽

Mycophenolate Mofetil ◽

Herpes Simplex ◽

Graft Rejection ◽

Penetrating Keratoplasty ◽

Systemic Treatment ◽

Herpes Simplex Infection ◽

Viral Agent ◽

Simplex Infection

Introduction: Keratitis due to herpes simplex infection is a common cause of corneal damage resulting in impaired vision. Aim: The aim of this study was to assess the outcome of penetrating keratoplasties in patients treated with systemic antiviral and immunosuppressive drugs. Method: The authors retrospectively analysed data of 12 patients who underwent penetrating keratoplasty. The average age at onset of the first keratitis preceding surgery was 18 years (between 5 and 40 years). The indication for surgery in 9 cases was to improve vision and in 3 patient to prevent corneal perforation. Nine patients were given both acyclovir and mycophenolate mofetil, as anti-viral agent and immunosuppressive treatment, respectively. Two patients were treated with anti-viral agent only while one patient received no systemic therapy. The average follow-up time was 53.1 months (between 16 and 84 months). Results: Of the 9 patients who underwent surgery for improving vision, 8 patients had transparent grafts during follow up without vascularization. All eight patients had been treated with acyclovir and mycophenolate mofetil. In one patient who had no systemic treatment recurrence and graft rejection was observed. Only one of the surgeries performed in acute stage of inflammation resulted in a properly healed transparent graft without recurrence and rejection. In this patient acyclivir and mycophenolate mofetil therapy had been given previously. In two cases the preventive – full or partial – systemic treatment had no effect. The visual acuity improved in all cases. In three patients visual acuity was influenced by some other factors as well. Conclusions: The systemic acyclovir and mycophenolat mofetil therapy is fairly successful in perforating keratoplasty due to herpes simplex infection. Acyclovir decreases the risk of recurrence, while mycophenolate mofetil may prevent graft rejection. The timing of surgery is decisive; it leads to better results when performed in a scarred, noninflammatory state. Orv. Hetil., 2013, 154(52), 2065–2070.

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