Update on the Management of High-Risk Penetrating Keratoplasty.
Update on the Management of High-Risk Penetrating Keratoplasty.
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DOI：
10.1007/s40135-017-0119-2
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发表时间：
2017-03
影响因子：
0.9
通讯作者：
Djalilian AR
中科院分区：
文献类型：
--
作者：
Jabbehdari S;Rafii AB;Yazdanpanah G;Hamrah P;Holland EJ;Djalilian AR
本文就高危穿透性角膜移植术的适应证及最新处理方法作一综述。尽管角膜具有免疫特权地位，但免疫介导的移植排斥反应仍然是角膜移植失败的主要原因。这在高风险的移植受者，即先前因排斥而导致移植失败的患者和角膜床发炎和血管化的患者中尤其是个问题。目前，包括局部和全身免疫抑制在内的许多策略被用于提高高风险角膜移植的成功率。此外，在角膜缘干细胞缺乏的情况下，采用角膜缘干细胞移植。皮质类固醇仍是预防和治疗角膜移植排斥反应的首选药物。免疫抑制剂如他克莫司、环孢素和霉酚酸酯是延长移植物存活的有希望的辅助疗法。在未来，细胞和分子疗法将使我们能够在高风险移植物中实现免疫耐受。
In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.