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Review
. 2023 Sep;71(9):3149-3159.
doi: 10.4103/IJO.IJO_228_23.

Management and prevention of corneal graft rejection

Sohini Mandal  1 , Prafulla K Maharana  1 , Luci Kaweri  2 , Mohamed I Asif  3 , Ritu Nagpal  1 , Namrata Sharma  1
Affiliations
Review

Management and prevention of corneal graft rejection

Sohini Mandal et al. Indian J Ophthalmol. 2023 Sep.

Abstract

The management of an episode of corneal graft rejection (CGR) is primarily by corticosteroids. Immunomodulators are useful for long-term immunosuppression and in dealing with cases of high-risk (HR) corneal grafts. The classical signs of CGR following penetrating keratoplasty (PKP) include rejection line, anterior chamber (AC) reaction, and graft edema. However, these signs may be absent or subtle in cases of endothelial keratoplasty (EK). Prevention of an episode of graft rejection is of utmost importance as it can reduce the need for donor cornea significantly. In our previous article (IJO_2866_22), we had discussed about the immunopathogenesis of CGR. In this review article, we aim to discuss the various clinical aspects and management of CGR.

Keywords: Corneal graft rejection; endothelial rejection; graft failure; immune privilege; keratoplasty.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) & (b) - Combined stromal and endothelial graft rejection 1 year following penetrating keratoplasty showing differential graft edema with stromal haze in the inferior half of the graft
Figure 2
Figure 2
(a) & (b) - Stromal graft rejection following anterior lamellar keratoplasty showing graft edema with diffuse stromal haze. (Note the loose sutures at 12 and 1 o’clock, which was responsible for the rejection); (c) & (d) - Complete resolution of the graft edema after intensive therapy with topical steroids
Figure 3
Figure 3
(a) & (b) - Endothelial rejection following DSAEK showing differential edema of the donor lenticule (inferior)
Figure 4
Figure 4
Flowchart showing preventive therapy targets of the basic pathophysiological processes involved in corneal graft rejection
See this image and copyright information in PMC

References

    1. Claesson M, Armitage WJ. Ten-year follow-up of graft survival and visual outcome after penetrating keratoplasty in Sweden. Cornea. 2009;28:1124–9. - PubMed
    1. Guilbert E, Bullet J, Sandali O, Basli E, Laroche L, Borderie VM. Long-term rejection incidence and reversibility after penetrating and lamellar keratoplasty. Am J Ophthalmol. 2013;155:560–9. e2. - PubMed
    1. Ing JJ, Ing HH, Nelson LR, Hodge DO, Bourne WM. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology. 1998;105:1855–65. - PubMed
    1. Keane MC, Lowe MT, Coster DJ, Pollock GA, Williams KA. The influence of Australian eye banking practices on corneal graft survival. Med J Aust. 2013;199:275–9. - PubMed
    1. Sellami D, Abid S, Bouaouaja G, Ben Amor S, Kammoun B, Masmoudi M, et al. Epidemiology and risk factors for corneal graft rejection. Transplant Proc. 2007;39:2609–11. - PubMed