Clinical observation of the characteristic of immune rejection after corneoscleral transplantation

Abstract

To study the clinical characteristic of immune rejection after corneoscleral transplantation. A retrospective study was performed on patients received corneoscleral transplantation in Shandong Eye Institute between July 2003 and July 2005. 14 cases were included in this study. Enrollment criterion: on the 7th day postoperatively, graft was transparent; depth of anterior chamber, intraocular pressure (IOP) and B scan were normal. The time, vision, symptom, characteristic, and outcome of immune rejection were recorded. The time and incidence of immune rejection were as following: 2 cases from day 11 to day 13; 10 cases from weeks to 1 month; 1 case in 3 months and 1 case in 6 months. Vision acuity decreased from 0.05 - 0.2 to finger counting (FC) or hand motion (HM) in all of cases with immune rejection; the major manifestation of immune rejection were circular limbal congestion, edema with circuitous and dilated vessel; the other characteristics of the rejection included whole graft edema, descemet membrane folds, shallow anterior chamber; endothelial rejection line or keratic precipitate (KP). IOP reduction < 10 mm Hg was seen 12 patients. Retina and choroids edema were found in 5 patients using B scan. After the diagnosis of immune rejection was established, 7 patients were treated with anti-rejection medication within 3 days, their grafts became transparent; 3 patients were treated within 3 - 5 day after the rejection, 2 grafts became transparent, 1 graft was suffered from endothelium decompensation; 4 patients were treated 7 days later after the rejection, 1 graft became transparent, 2 grafts were suffered from endothelium decompensation and 1 eye was atrophied. After corneoscleral transplantation, the characteristic of immune rejection includes circular limbal congestion, whole graft edema, shallow anterior chamber and low IOP. Immediately anti-rejection treatment is critical for the prognosis after immune rejection.