Abstract
Corneal transplantation is a method of surgical treatment used to restore the optical and structural properties of the diseased cornea which is successfully performed for over 100 years. The immune rejection remains one of the most common causes of an unsatisfactory outcomes of penetrating keratoplasty. The cases of corneal allograft rejection range from 2.3% to 65% depending on the risk factors taking place in the recipient. The most well-known risk factors for corneal allograft rejection are neovascularization of the recipient’s cornea, active ocular inflammation, herpetic keratitis, ocular surface disease, young age, previous surgery of the anterior segment of the eye, neurotrophic keratopathy, big and eccentric graft, anterior synechia. Given the fact that the pathophysiology of corneal graft rejection is very complex and not fully understood the applied methods of treatment and prevention are often ineffective in “high risk” patients. New experimental targeted approaches including the use of antibodies and gene therapy are currently being developed but do not have a clear success in the clinic yet.Therefore for obtaining satisfactory outcomes of corneal transplantation in “high risk” patients all main known risk factors have to be taken into account with subsequent possible preoperative therapy to reduce their impact; careful monitoring of the patient in the postoperative period should be done to early detection of allograft rejection signs; optimal schemes and combinations of immunosuppressive drugs authorized for use in the clinic have to be developed.
Highlights
Corneal transplantation is a method of surgical treatment used to restore the optical and structural properties of the diseased cornea which is successfully performed for over 100 years
2017;14(3):180–187 in the clinic yet. for obtaining satisfactory outcomes of corneal transplantation in “high risk” patients all main known risk factors have to be taken into account with subsequent possible preoperative therapy to reduce their impact; careful monitoring of the patient in the postoperative period should be done to early detection of allograft rejection signs; optimal schemes and combinations of immunosuppressive drugs authorized for use in the clinic have to be developed
Dastjerdi M, Saban D, Okanobo A et al Effects of Topical and Subconjunctival Bevacizumab in High-Risk Corneal Transplant Survival
Summary
Случаи реакции отторжения трансплантата роговицы встречаются в 2,3–65% в зависимости от факторов риска, имеющих место у реципиента. Что патофизиология реакции отторжения роговичного трансплантата очень сложна и полностью не изучена, применяемые методы ее лечения и профилактики у пациентов «высокого риска» часто оказываются неэффективными. В связи с этим для получения удовлетворительных результатов трансплантации роговицы у пациентов «высокого риска» необходимы учет всех основных известных факторов риска с последующей максимально возможной предоперационной терапией, уменьшающей их влияние; тщательный мониторинг пациента в послеоперационном периоде для максимально раннего выявления признаков реакции тканевой несовместимости; разработка оптимальных схем и комбинаций иммуносупрессивных препаратов, разрешенных к использованию в клинике. Ключевые слова: реакция отторжения трансплантата роговицы, кератопластика «высокого риска», факторы риска, иммуносупрессивная терапия, циклоспорин А, такролимус. Прозрачность финансовой деятельности: Никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах
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