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Article
April 1981

Clinical Types of Corneal Transplant RejectionTheir Manifestations, Frequency, Preoperative Correlates, and Treatment

Author Affiliations

From the Iowa Lions Cornea Center, Department of Ophthalmology, University of Iowa Hospitals, Iowa City. Dr Alldredge is now in private practice in Salt Lake City.

Arch Ophthalmol. 1981;99(4):599-604. doi:10.1001/archopht.1981.03930010599002
Abstract

• We report a retrospective series of 156 penetrating keratoplasties that were performed in 144 patients during a two-year period, with a minimum of one-year follow-up. Three different types of rejection were identified—endothelial rejection, epithelial rejection, and subepithelial infiltrates (SEIs). We also report the clinical signs, frequency, preoperative correlates, significance, and treatment of each type of rejection. The overall frequency of any kind of rejection was 29%. Endothelial rejection was seen in 21% of the grafts, epithelial rejection was seen in 10% of the grafts, and SEIs were seen in 15% of the grafts. The frequency of endothelial rejection increased with preoperative corneal vascularization. All three types of rejection decreased in frequency with the increasing age of the recipient. Endothelial rejection was more successfully treated in the cases that had no preoperative stromal vascularization.

References
1.
Khodadoust AA:  The allograft rejection reaction: The leading cause of late failure of clinical corneal grafts , in Porter R, Knight J (eds): Corneal Graft Failure . Amsterdam, Associated Scientific Publishers, 1973, pp 151-164.
2.
Paufique L, Sourdille GD, Offret G (eds): Les Greffes de la Corn ée. Paris, Masson & Cie, 1948, pp 131-136.
3.
Maumenee AE:  The influence of donor-recipient sensitization on corneal grafts . Am J Ophthalmol 34:142-152, 1951.
4.
Maumenee AE:  Clinical aspects of the corneal homograft reaction . Invest Ophthalmol 1:244-252, 2962.
5.
Khodadoust AA, Silverstein AM:  Transplantation and rejection of individual cell layers of the cornea . Invest Ophthalmol 8:180-195, 1969.
6.
Polack FM:  Scanning electron microscopy of the corneal graft reaction . Invest Ophthalmol 11:1-14, 1972.
7.
Polack FM, Kanai A:  Electron microscopic studies of graft endothelium in corneal graft rejection . Am J Ophthalmol 73:711-717, 1972.
8.
Krachmer JH,  Alldredge OC: Subepithelial infiltrates: A probable sign of corneal graft rejection . Arch Ophthalmol 96:2234-2237, 1978.Article
9.
Polack FM:  Clinical and pathological aspects of the corneal graft reaction . Trans Am Acad Ophthalmol Otolaryngol 77:418-431, 1973.
10.
Offret G, Pouliquen Y, Guyot D:  Aspects cliniques des reáctions immunitaries après kératoplasties transfixiantes chez l'homme . Arch Ophtalmol 30:209-218, 1970.
11.
Gibbs DC, Batchelor JR, Werb A, et al:  The influence of tissue-type compatibility on the fate of full-thickness corneal grafts . Trans Ophthalmol Soc UK 94:101-126, 1974.
12.
Chandler JW, Kaufman HE:  Graft reactions after keratoplasty for keratoconus . Am J Ophthalmol 77:543-547, 1974.
13.
Keates RH, Falkenstein S:  Keratoplasty in keratoconus . Am J Ophthalmol 74:442, 1972.
14.
Anseth A:  Keratoplasty for keratoconus . Acta Ophthalmol 45:684, 1967.Article
15.
Donshik PC, Cavanagh HD, Boruchoff SA, et al:  Effect of bilateral and unilateral grafts on the incidence of rejections in keratoconus . Am J Ophthalmol 87:823-826, 1979.
16.
Fine M, Stein M:  The role of corneal vascularization in human corneal graft reactions , in Porter R, Knight J (eds): Corneal Graft Failure . Amsterdam, Associated Scientific Publishers, 1973, pp 193-204.
17.
Cherry PMH, Pashby RC, Tadros ML, et al:  An analysis of corneal transplantation: I-graft clarity . Ann Ophthalmol 11:461-469, 1979.
18.
Owens WC, Frank JJ, Leahey B, et al:  Symposium: Corneal transplantation—results . Am J Ophthalmol 31:1344-1399, 1948.
19.
Medawar PB:  Immunity to homologous grafted skin . Br J Exp Pathol 29:58-69, 1948.
20.
Billingham RE, Boswell T:  Studies on the problems of corneal homografts . Proc R Soc Lond Biol 141:392-408, 1953.Article
21.
Polack FM:  Histopathological and histochemical alterations in the early stages of corneal graft rejection . J Exp Med 116:709-717, 1962.Article
22.
Polack FM:  Corneal transplantation . Invest Ophthalmol 12:85-86, 1973.
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