Jordan C S, Price M O, Trespalacios R, Price F W
Cornea Research Foundation of America, 9002 N. Meridian Street, Ste. 212, Indianapolis, IN 46260, USA.
Br J Ophthalmol. 2009 Mar;93(3):387-90. doi: 10.1136/bjo.2008.140020. Epub 2008 Nov 19.
To investigate characteristics of initial immunological graft rejection after Descemet stripping with endothelial keratoplasty (DSEK).
The incidence, symptoms and clinical characteristics of initial immunological graft rejection episodes were analysed retrospectively in 598 eyes treated with primary DSEK at a single tertiary referral centre.
Graft rejection episodes occurred in 54 eyes of 48 patients. Thirty-five per cent of the eyes were asymptomatic and were diagnosed during routine examination. Signs of immunological rejection at the initial diagnosis included keratic precipitates (69%), diffuse corneal oedema (11%) or both (20%); no endothelial rejection lines were observed. In contrast to standard full-thickness grafts, there were no epithelial immunological reactions because the epithelium and anterior stroma are not transplanted in DSEK. Most grafts cleared; four (7%) progressed to graft failure and were successfully regrafted with DSEK.
Immunological graft rejection is an important postoperative complication after DSEK. The range of clinical findings indicative of corneal graft rejection differs in some respects between DSEK and standard penetrating keratoplasty.
研究深板层内皮角膜移植术（DSEK）后初次免疫性移植排斥反应的特征。
回顾性分析在一家三级转诊中心接受初次DSEK治疗的598只眼，分析初次免疫性移植排斥反应发作的发生率、症状及临床特征。
48例患者的54只眼发生了移植排斥反应。35%的患眼无症状，在常规检查时被诊断出来。初次诊断时免疫排斥反应的体征包括角膜后沉着物（69%）、弥漫性角膜水肿（11%）或两者皆有（20%）；未观察到内皮排斥线。与标准的全层移植不同，由于DSEK中未移植上皮和前基质，因此不存在上皮免疫反应。大多数移植片情况好转；4只眼（7%）进展为移植失败，并成功再次接受DSEK移植。
免疫性移植排斥反应是DSEK术后一种重要的并发症。在某些方面，DSEK与标准穿透性角膜移植术之间，提示角膜移植排斥反应的临床发现范围有所不同。
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