Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms
Graft rejection episodes after Descemet stripping with endothelial keratoplasty: part one: clinical signs and symptoms
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DOI：
10.1136/bjo.2008.140020
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发表时间：
2009-03-01
影响因子：
4.1
通讯作者：
Price, F. W., Jr.
中科院分区：
文献类型：
--
作者：
Jordan, C. S.;Price, M. O.;Price, F. W., Jr.
目的：探讨角膜内皮移植术（DSEK）后角膜内皮剥离术后的免疫排斥反应特点。方法：回顾性分析某三级转诊中心598例原发性DSEK患者的首发免疫排斥事件的发生率、症状和临床特点。结果：48例患者54眼发生移植排斥反应。35%的眼睛无症状，在常规检查中被诊断出来。最初诊断时的免疫排斥症状包括角膜沉淀（69%）、弥漫性角膜水肿（11%）或两者兼有（20%）；未观察到内皮排斥线。与标准全层移植物相比，由于在DSEK中没有移植上皮和前基质，因此没有上皮免疫反应。大部分移植物被清除；4例（7%）进展为移植物失败，并成功地用DSEK移植。结论：移植物免疫排斥反应是DSEK术后重要的并发症。DSEK和标准穿透性角膜移植术的临床表现范围在某些方面不同。
Aim: To investigate characteristics of initial immunological graft rejection after Descemet stripping with endothelial keratoplasty (DSEK).Methods: The incidence, symptoms and clinical characteristics of initial immunological graft rejection episodes were analysed retrospectively in 598 eyes treated with primary DSEK at a single tertiary referral centre.Results: Graft rejection episodes occurred in 54 eyes of 48 patients. Thirty-five per cent of the eyes were asymptomatic and were diagnosed during routine examination. Signs of immunological rejection at the initial diagnosis included keratic precipitates (69%), diffuse corneal oedema (11%) or both (20%); no endothelial rejection lines were observed. In contrast to standard full-thickness grafts, there were no epithelial immunological reactions because the epithelium and anterior stroma are not transplanted in DSEK. Most grafts cleared; four (7%) progressed to graft failure and were successfully regrafted with DSEK.Conclusions: Immunological graft rejection is an important postoperative complication after DSEK. The range of clinical findings indicative of corneal graft rejection differs in some respects between DSEK and standard penetrating keratoplasty.