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Failed grafts after high-risk penetrating keratoplasty and role of immunological monitoring in the optimisation of its treatment

Poster Details

First Author: A.Kugusheva RUSSIA

Co Author(s):    P. Makarov   O. Slepova   E. Mironkova        

Abstract Details



Purpose:

Analysis of main reasons of graft rejection appearance and ways of treatment"s effectiveness increase after high-risk penetrating keratoplasty due to clinical and immunological monitoring

Setting:

Due to modern microsurgical technologies and new medicine development penetrating keratoplasty is considered to be ordinary operation today. But distant results especially after so called high-risk penetrating keratoplasty are still unsatisfactory – graft rejection in 5-70%

Methods:

we observed 46 patients with postinflammatory (20), after-burn (9) and posttraumatic (3) leukomas who had penetrating keratoplasty. Retrospectively all patients were divided into 2 groups: 1 – without complications (22patients) and 2 – with complications (24 patients) during postoperative period. Criteria for comparison were: time of epithelization"s completion, keratoplasty in anamnesis, inner eyelid"s plate deformation, immunosupressive therapy (topical and system steroid therapy, cyclosporine A), indicators of systemic autoimmunization to corneal antigens (in vitro), cytokine imbalance signs, Herpes virus activation ( IgM- ab or ab to early HSV-Ag ; ELISA) and exposure of Herpes virus DNA in donor"s cornea and recipient"s cornea and blood by PCR. Follow-up period: 1-24 months

Results:

Comparative analysis showed that the main factors which assign risk of postoperative complications" appearance are leukoma"s or ulcer"s inflammatory etiology, eyelid inner plate"s deformation, repeated operation keratoplasty, non-use of cyclosporine A and long period of cell immune response to corneal antigens, inflammatory mediator"s in serum very high or very low (absence) level"s. Herpes virus DNA presence in donor or recipient cornea especially when protective antibodies are not enough and antiviral therapy is not used

Conclusions:

Derived findings testify that unsatisfactory results after penetrating keratoplasty can be consequence of both hard clinical state of operated eyes and inadequate therapy during postoperative period. Inefficiency of conservative therapy can be caused by very special immune reaction"s variability especially in so called high-risk groups. This fact assigns the necessity of individual scheme of treatment and its correction during clinical and immunological monitoring taking into account autoimmune reactions such as general immunoreactivity and infectious factor"s presence.

Financial Disclosure:

NONE

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