Shimazaki J, Maruyama F, Shimmura S, Fujishima H, Tsubota K
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan.
Cornea. 2001 Mar;20(2):149-52. doi: 10.1097/00003226-200103000-00006.
To study the incidence and prognosis of immunologic rejection of the central graft after limbal allograft transplantation (keratolimbal allograft transplantation [KLAT]) combined with penetrating keratoplasty (PKP).
Endothelial rejection in central penetrating graft after simultaneous KLAT and PKP using the same donor cornea was retrospectively studied. Incidence, reversibility, prognosis, and changes in limbal grafts were examined.
Forty-five eyes underwent simultaneous PKP and KLAT. Endothelial rejection of the central graft was found in 16 eyes (35.6%). At last examination, 10 grafts (62.5%) restored clarity after immunosuppressive therapy. During rejection episodes, four eyes showed engorgement of vessels in limbal grafts, which existed before the episodes. Only one eye developed neovascularization with mild edema of the limbal grafts; however, no other limbal grafts showed abnormalities on biomicroscopy. No epithelial changes were noted, and 14 grafts (87.5%) were covered by corneal epithelium after the rejection.
Approximately one third of eyes had endothelial rejection in the central graft after simultaneous KLAT and PKP. Abnormalities suggestive of rejection in the limbal grafts were seldom observed in these eyes, suggesting that immunologic response was different in central and limbal grafts.
研究角膜缘移植联合穿透性角膜移植术（角膜缘全层移植术[KLAT]）后中央移植物免疫排斥反应的发生率及预后。
回顾性研究使用同一供体角膜同时行KLAT和PKP后中央穿透性移植物的内皮排斥反应。检查其发生率、可逆性、预后及角膜缘移植物的变化。
45只眼同时接受了PKP和KLAT。16只眼（35.6%）发生了中央移植物的内皮排斥反应。在最后一次检查时，10只移植物（62.5%）在免疫抑制治疗后恢复透明。在排斥反应发作期间，4只眼的角膜缘移植物血管充血，这种情况在发作前就已存在。只有1只眼角膜缘移植物出现新生血管并伴有轻度水肿；然而，在生物显微镜检查中，没有其他角膜缘移植物显示异常。未观察到上皮变化，14只移植物（87.5%）在排斥反应后被角膜上皮覆盖。
同时行KLAT和PKP后，约三分之一的眼中央移植物发生内皮排斥反应。在这些眼中很少观察到角膜缘移植物有提示排斥反应的异常情况，这表明中央和角膜缘移植物的免疫反应不同。
