Clinical characteristics of corneal endotheliitis and endothelial rejection following corneal transplantation

Abstract

Background The administration of glucocorticoid drugs and immunosupressor results in reducing immune competence and therefore induces inflammatory lesions, such as corneal endotheliitis and endothelial rejection.Corneal endotheliitis and endothelial rejection have rather similar clinical manifestations, but their managements are different, therefore, their differential diagnosis is very important. Objective This study aimed to observe and compare the clinical characteristics of viral corneal endotheliitis and endothelial rejection following corneal transplantation. Methods The clinical data of 29 cases with corneal endothelial inflammatory reaction following corneal transplantation from January 2011 to September 2013 were retrospectively analyzed in Peking University Eye Center.The examinations included ocular anterior segment findings by slit lamp microscope and confocal laser scanning microscope, intraocular pressure (IOP) measurement by Goldmann tonometer and serum lgG detection.The patients were divided into corneal endotheliitis group 17 patients and endothelial rejection group 12 patients according to clinical findings.The combination of antiviral therapy with glucocorticoid drugs or the combination of topical glucocorticoid drugs with immunosupressor was carried out on the two groups, respectively.Brimonidine tartrate eye drops or timolol eye drops was used to lower IOP.The clinical characteristics between corneal endotheliitis and endothelial rejection after corneal transplantation were compared and differentiated. Results The patients received penetrating corneal transplantation, and the number of different corneal diseases was significant different between the two groups (P=0.000). The IOP in the endothelial rejection group was (16.00±3.19)mmHg, which was significantly lower than (34.00±3.84)mmHg in the corneal endotheliitis (t=13.298, P=0.000). The onset time after operation was (21.92±8.60)months and the age was (44.00±16.71)years in the endothelial rejection group, and those in the corneal endotheliitis group were (14.41±5.79)months and (57.24±12.66) years, showing significant differences between the two groups (t=-2.816, P=0.009; t=2.429, P=0.022). In the corneal endotheliitis group, the eyes with corneal endotheliitis showed scatter-arranged pigmented keratic precipitates (KP) and edema of grafts and recipient bed, and many irregularly arranged Langhans cells were seen in the stroma.The damage of corneal endothelial cells was irreversible; while in the endothelial rejection group, the corneal endothelium was clear with regularly arranged KP.Only graft edema and regularly distributing Langhans cells were found, and the damage of endothelial cells was reversible after treatment.There were not significant differences in the serum lgG level and gender between the two groups (both at P>0.05). Conclusions The corneal edema, KP and inflammatory reaction are more serious in the corneal endotheliitis eyes in comparison with endothelial rejection following penetrating corneal transplantation.IOP raising primarily appears in corneal endotheliitis eyes.Over 70-year old patients are likely diagnosed as corneal endotheliitis.The onset of corneal endothelial inflammation is later in endothelial rejection than that in corneal endotheliitis.The initial corneal diseases should be considered in the process of differentiatial diagnosis. Key words: Corneal transplantation; Endothelium, corneal/pathology; Keratoplasty, penetrating/adverse effects; Graft rejection; Keratitis/complications; Postoperative complications; Corneal endotheliitis