Di Zazzo Antonio, Kheirkhah Ahmad, Abud Tulio B, Goyal Sunali, Dana Reza
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Surv Ophthalmol. 2017 Nov-Dec;62(6):816-827. doi: 10.1016/j.survophthal.2016.12.010. Epub 2016 Dec 22.
The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered; however, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been used for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use, as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments, as well as tolerance-inducing methods, show promising horizons in the management of high-risk corneal transplantation in near future.
角膜是医学上最常移植的组织。角膜移植失败的主要原因是同种异体移植排斥反应。移植排斥反应的发生率取决于高风险特征的存在，最显著的是角膜新生血管形成。尽管在没有这些风险因素的情况下角膜移植成功率很高，但由于免疫介导的移植排斥反应发生率高，高风险角膜移植的成功率较低。为提高高风险角膜移植的存活率，可以考虑各种术前、术中和术后措施；然而，这些移植物管理的关键步骤是长期使用局部和/或全身免疫抑制剂。尽管已经使用了多种免疫抑制剂来达到这一目的，但不同研究的结果差异很大。这部分是由于缺乏优化的使用方法，以及缺乏对每个患者风险程度的精确分层。新的靶向生物治疗以及诱导耐受的方法，在不久的将来对高风险角膜移植的管理显示出广阔的前景。
