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Confocal microscopy of corneal graft rejection
R A Cohen1, S J Chew, B M Gebhardt
1LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112-2234, USA.
Insights
This study shows that scanning confocal microscopy can detect early signs of corneal graft rejection in rabbits, including cell infiltration and fibrosis, aiding in diagnosis.
Area of Science:
- Ophthalmology
- Immunology
- Biomedical Engineering
Background:
- Corneal transplantation is a common procedure.
- Graft rejection remains a significant challenge.
- Early detection of rejection is crucial for graft survival.
Purpose of the Study:
- To evaluate scanning confocal microscopy (SCM) for early detection of corneal allograft rejection.
- To compare SCM findings with slit-lamp biomicroscopy in rabbit eyes.
Main Methods:
- Corneal allografts were transplanted into inflamed rabbit eyes.
- Grafts were examined using slit-lamp biomicroscopy and SCM every 4 days.
- Confocal images were captured and computer-enhanced in real-time.
Main Results:
- Early signs of rejection, including epithelial rejection lines, cloudiness, and edema, were observed.
- SCM revealed infiltrating cells in the graft stroma, particularly around sutures.
- Vascularization, leukocyte infiltrates, reduced keratocyte density, and fibrosis were noted.
Conclusions:
- SCM can identify early indicators of antigraft immune response in corneal allografts.
- SCM may serve as a valuable clinical tool for diagnosing corneal inflammation and rejection.
Abstract:
Corneal allografts were transplanted into inflamed and vascularized graft beds in rabbit eyes. The grafts were examined every 4 days by slit-lamp biomicroscopy and scanning confocal microscopy. Confocal images were recorded with a video camera and computer enhanced in real-time. Layers of the cornea were visualized in serial optical sections parallel to the epithelium. In the third postoperative week, signs of graft rejection were observed; slit-lamp examination revealed a circumferential line of epithelial rejection, along with cloudiness and edema. Vessels were observed growing into the graft. By confocal microscopy, infiltrating cells were seen in the graft stroma. Foci of cells were especially pronounced around the sutures. Scattered leukocyte infiltrates were prominent at capillary terminals. There was an accompanying reduction in the stromal keratocyte density in the region of the infiltrate. Additionally, various degrees of fibrosis were noted around each suture and at the host-graft interface. Confocal microscopy may provide a valuable clinical tool for determining the earliest indicators of an antigraft immune response, and as an aid in the differential diagnosis of other inflammatory conditions of the cornea.