Immune reactions following keratoplasty

Abstract

On the basis of follow-up examinations of 236 penetrating keratoplasties the different forms of immune reaction were analyzed with special regard to their relationship to indication and prognosis. An immune reaction was observed in 42.8% of the cases. An epithelial Khodadoust line occurred in 17 transplants (7.2%). Nine of these were early reactions within the first two months after reoperation. Subepithelial infiltrates occurred in 14 grafts (5.9%), usually as late complications except after reoperation. Special risk factors are anterior synechiae, chronic inflammation and regrafts. The lower risk group differs from the high risk group with regard to a) the epithelial Khodadoust line (2.9% vs. 10.6%), b) the severs forms of endothelial immune reactions (4.8% vs. 32.6%), and c) the irreversible immune reactions (0% vs. 23.5%). Subepithelial infiltrates and mild forms of precipitates occurred about equally in both groups. The different forms of endothelial immune reactions are of prognostic value only in connection with the individual diagnosis and indication. About 50% of the late immune reactions were of iatrogenic origin. Misalignment of the graft can lead to a typical Khodadoust line. In one patient an irreversible immune reaction of the diffuse type was caused by YAG laser treatment of a secondary membrane.