Latifi Golshan, Katoozpour Ramon, Ghaffari Reza, Abdi Parisa, Kasiri Maryam, Berijani Sahar
Cornea Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J Curr Ophthalmol. 2021 Oct 22;33(3):291-297. doi: 10.4103/joco.joco_211_20. eCollection 2021 Jul-Sep.
To evaluate the microstructural corneal changes during acute endothelial graft rejection and following treatment using confocal microscopy (IVCM).
Patients with a clinical diagnosis of severe acute endothelial graft rejection following penetrating keratoplasty were included in this study. IVCM was performed on the 1 day the patient presented with rejection signs and at the time of clinical resolution.
Twenty-three patients were included in this study. Inflammatory cells appeared as dendritic cells (DCs) and less frequently, as non-DCs in basal epithelial and subbasal areas. Activated keratocytes (AKs) (type 1: large cells with visible cytoplasmic processes; type 2: elongated and spindle-shaped keratocytes) were visible in acute phase. Following resolution, type 1 AKs considerably reduced, but type 2 cells were more often persisted. Multiple types of keratic precipitates (KPs) were also visible in acute phase which resolved following resolution of rejection.
Acute graft rejection was associated with an increase in the number of DCs, activation of keratocytes, and aggregation of various types of KPs. Inflammatory process subsided in almost all cases, but the IVCM changes did not return to normal early after clinical resolution of rejection.
使用共聚焦显微镜（IVCM）评估急性内皮移植排斥反应期间及治疗后的角膜微观结构变化。
本研究纳入穿透性角膜移植术后临床诊断为严重急性内皮移植排斥反应的患者。在患者出现排斥体征的第1天以及临床症状缓解时进行IVCM检查。
本研究纳入了23例患者。炎症细胞表现为树突状细胞（DCs），在基底上皮和基底膜下区域较少表现为非DCs。急性期可见活化角膜细胞（AKs）（1型：具有可见细胞质突起的大细胞；2型：细长梭形角膜细胞）。症状缓解后，1型AKs显著减少，但2型细胞更常持续存在。急性期还可见多种类型的角膜后沉着物（KPs），排斥反应缓解后消失。
急性移植排斥反应与DCs数量增加、角膜细胞活化以及多种类型KPs的聚集有关。几乎所有病例的炎症过程均消退，但排斥反应临床缓解后早期IVCM变化并未恢复正常。
