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Impressum
Immunologic Graft Reactions after Allogenic Penetrating Keratoplasty
1Jonas J. B., 2Rank R., 2Budde W. M.
1Universitäts-Augenklinik, Fakultät für Klinische Mannheim der Universität Heidelberg, Mannheim, 2Augenklinik mit Poliklinik, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
Purpose: To evaluate frequency and risk factors of immunologic
graft reactions after allogenic penetrating keratoplasty.
Patients and Methods: The retrospective clinical interventional
comparative non-randomized study included 342 patients (eyes). The patients
consecutively underwent penetrating keratoplasty performed by a single
surgeon in the study period from 1989 to 1997. Follow-up period was at
least 12 months (mean ± S.D., 31.3 ± 18.7 months). Main
outcome measures were frequency of immunologic graft reactions.
Results: Immunologic graft reactions were detected in 47 patients
(47/342=13.7%). Statistically significant risk factors (P<0.05) for
the development of graft reactions were loosening of sutures, and preoperative
and postoperative corneal vascularization. Frequency of an immunologic
graft reaction was statistically independent (P>0.05) of the graft
diameters used in the present study, age, gender, and right or left eye
of the patients, HLA-typing, age of the donor, and preservation data of
the donor material. Seventy-five percent (35/47) of all graft reactions
were detected within the first 2.5 years after surgery. Twelve percent
(6/47) of all graft reactions were observed more than 4 years after keratoplasty.
With intensive steroid treatment, graft transparency could be regained
in 44 of the 47 (44/47=94%) patients with an immunologic graft reaction.
Conclusions: Most important risk factors for immunologic graft
reactions occurring in about 14% of patients after allogenic penetrating
keratoplasty are suture loosening, and preoperative and postoperative
corneal vascularization. Graft diameters as used in the present study,
HLA-typing, age of the donor, and preservation data of the donor material
may not play a major role. More than 10% of graft reaction episodes can
occur more than 4 years post-grafting. With intensive steroid treatment,
graft transparency can be regained in the majority of patients after an
immunologic graft reaction, when detected early.