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Advances in corneal graft rejection
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
Current Opinion in Ophthalmology
|May 14, 2021
Summary
Immune rejection is a major cause of graft failure in penetrating keratoplasty. Newer lamellar keratoplasty techniques show significantly lower rejection rates, though their long-term failure causes need more study.
Area of Science:
- Ophthalmology
- Immunology
- Transplantation
Background:
- Immune rejection poses a significant risk for corneal graft failure, particularly in penetrating keratoplasty (PKP).
- While HLA matching has been explored, its impact on high-risk PKP rejection is not definitively established.
Purpose of the Study:
- To review recent advancements in understanding and managing immune rejection following corneal transplantation.
- To compare rejection rates across different corneal transplantation techniques.
Main Methods:
- Review of recent literature on corneal transplantation and immune rejection.
- Analysis of reported graft failure and rejection rates for various keratoplasty procedures.
Main Results:
- Penetrating keratoplasty (PKP) has higher immune rejection rates compared to lamellar keratoplasty techniques.
- Lamellar keratoplasty procedures like DALK, DSAEK, and DMEK demonstrate substantially lower rejection rates (1.7-13%).
- Topical treatments like tacrolimus and anti-VEGF agents show potential for managing rejection in high-risk cases.
Conclusions:
- Immune rejection remains a primary concern for graft survival in PKP.
- Lamellar keratoplasty techniques offer a reduced risk of immune rejection compared to PKP.
- Further research is needed to clarify the role of immune rejection in the failure of lamellar corneal grafts.
