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Sclerokeratitis after keratoplasty in atopy
C J Lyons1, J K Dart, W A Aclimandos
1Moorfields Eye Hospital, London, England.
Ophthalmology
|June 1, 1990
Summary
Severe sclerokeratitis can develop after keratoplasty in atopic patients. High-dose oral steroids effectively controlled inflammation, suggesting a role for immunoglobulin E (IgE) in pathogenesis.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Keratoplasty, a surgical procedure to restore vision, can be complicated by inflammatory conditions.
- Atopic individuals may have a higher risk of developing ocular inflammatory diseases.
Observation:
- A series of five atopic patients developed severe sclerokeratitis 1-4 weeks post-keratoplasty.
- Symptoms included acute discomfort, photophobia, hyperemia, and mucus production, leading to suture loosening.
- Microbial keratitis and graft rejection occurred in some cases.
Findings:
- Elevated serum immunoglobulin E (IgE) levels (421-8434 kU/l) were observed in all affected patients.
- The proposed mechanism involves IgE binding to conjunctival mast cells, triggering degranulation and inflammation.
- High-dose oral steroid treatment successfully controlled the inflammatory reaction without recurrence upon cessation.
Implications:
- Early immunosuppression with oral steroids is recommended for atopic patients experiencing post-keratoplasty sclerokeratitis.
- Utilizing interrupted sutures may help prevent suture loosening.
- Managing risk factors for microbial keratitis is crucial in these patients.