Corneal Graft Rejection Follow-up

  • Author: Jason Jacobs, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 17, 2010
 

Further Outpatient Care

  • Patients should receive follow-up care for corneal graft rejection as needed.
Next

Complications

  • Depending on the degree of injury sustained by the graft, graft rejection episodes can progress to graft failure due to rejection.
Previous
Next

Prognosis

  • The sooner an episode of graft rejection is detected clinically and therapy is begun, the better the prognosis for graft survival. The rate of reversal of corneal endothelial graft rejection has been reported from 50-91%, depending on the clinical setting. In general, the prognosis is good if therapy is immediately instituted.
  • Depending on the degree of irreversible damage to the graft endothelium, even markedly edematous grafts may clear again. Once endothelial destruction has progressed to the point where the remaining endothelial function is inadequate to maintain deturgescence, the graft fails and becomes irreversibly edematous. Unfortunately, the endothelium has no or at best a very limited capacity for repair through mitosis.
Previous
Next

Patient Education

  • No symptoms are related universally to graft rejection.
  • Astute patients may complain of a decrease in visual acuity, redness, pain, irritation, and photophobia. Patients may also be asymptomatic.
  • Any patient with a corneal graft should be instructed to seek ophthalmologic care urgently if these symptoms persist for more than a few hours.
Previous
 
Contributor Information and Disclosures
Author

Jason Jacobs, MD  Clinical Faculty, Department of Ophthalmology, University of Colorado Health Sciences Center

Jason Jacobs, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, International Society of Refractive Surgery, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Taravella, MD  Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Professor, Department of Ophthalmology, University of Colorado School of Medicine

Michael Taravella, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America

Disclosure: Alcon Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Surgical Specialties Honoraria Speaking and teaching; BD Surgical Supplies Honoraria Speaking and teaching

Specialty Editor Board

Jack L Wilson, PhD  Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis

Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Lee HS, Kim MS. Influential factors on the survival of endothelial cells after penetrating keratoplasty. Eur J Ophthalmol. Nov-Dec 2009;19(6):930-5. [Medline].

  2. Bertelmann E, Pleyer U. Immunomodulatory therapy in ophthalmology - is there a place for topical application?. Ophthalmologica. Nov-Dec 2004;218(6):359-67. [Medline].

  3. Sloper CM, Powell RJ, Dua HS. Tacrolimus (FK506) in the management of high-risk corneal and limbal grafts. Ophthalmology. Oct 2001;108(10):1838-44. [Medline].

  4. Boisjoly HM, Tourigny R, Bazin R, Laughrea PA, Dube I, Chamberland G, et al. Risk factors of corneal graft failure. Ophthalmology. Nov 1993;100(11):1728-35. [Medline].

  5. Chen YF, Gebhardt BM, Reidy JJ, Kaufman HE. Cyclosporine-containing collagen shields suppress corneal allograft rejection. Am J Ophthalmol. Feb 15 1990;109(2):132-7. [Medline].

  6. Hegde S, Beauregard C, Mayhew E. CD4(+) T-cell-mediated mechanisms of corneal allograft rejection: role of Fas-induced apoptosis. Transplantation. Jan 15 2005;79(1):23-31. [Medline].

  7. Hill JC. Systemic cyclosporine in high-risk keratoplasty. Short- versus long-term therapy. Ophthalmology. Jan 1994;101(1):128-33. [Medline].

  8. Hill JC. The use of cyclosporine in high-risk keratoplasty. Am J Ophthalmol. May 15 1989;107(5):506-10. [Medline].

  9. Hill JC, Maske R, Watson P. Corticosteroids in corneal graft rejection. Oral versus single pulse therapy. Ophthalmology. Mar 1991;98(3):329-33. [Medline].

  10. Hwang DG, Stern WH, Hwang PH, MacGowan-Smith LA. Collagen shield enhancement of topical dexamethasone penetration. Arch Ophthalmol. Sep 1989;107(9):1375-80. [Medline].

  11. Khodadoust AA, Silverstein AM. Transplantation and rejection of individual layers of the cornea. In: Investigative Ophthalmologic and Visual Sciences. Vol 8. 180-195.

  12. Reidy JJ, Gebhardt BM, Kaufman HE. The collagen shield. A new vehicle for delivery of cyclosporin A to the eye. Cornea. Jul 1990;9(3):196-9. [Medline].

  13. Smolin G, Thoft RA. The cornea. In: Scientific Foundations and Clinical Practice. 3rd ed. Lippincott William & Wilkins; 1994.

  14. Wang M, Lin Y, Chen J, Liu Y, Xie H, Ye C. Studies on the effects of the immunosuppressant FK-506 on the high-risk corneal graft rejection. Yan Ke Xue Bao. Sep 2002;18(3):160-4. [Medline].

  15. Wilson SE, Kaufman HE. Graft failure after penetrating keratoplasty. Surv Ophthalmol. Mar-Apr 1990;34(5):325-56. [Medline].

 
Previous
Next
 
This severely vascularized cornea would be at high risk for graft rejection following a penetrating keratoplasty. This patient experienced Stevens-Johnson syndrome.
This is an example of an acute graft rejection episode. Note the graft edema, Descemet folds, and keratic precipitates.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.