Analysis of Immune Cells on Donor Corneal Endothelium After Corneal Transplantation Using the HRT-Rostock Cornea Module

Abstract

The aim of this study was to investigate the immune cells on corneal endothelium of the graft in patients who underwent penetrating keratoplasty (PK), Descemet-stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK).Methods: A total of 43 eyes of 43 patients who underwent PK (17 eyes), DSEK (13 eyes), and DMEK (13 eyes) and who did not show any sign of graft rejection were recruited for the study. Patients who underwent cataract surgery (26 eyes) served as controls. Immune cells on the corneal endothelium were examined with laser in vivo confocal microscopy. The associations between the corneal endothelial cell density, type of keratoplasty, aqueous flare, repeated keratoplasty, and time after surgery versus the density of immune cells were investigated. Results:In vivo confocal microscopy visualized similar numbers of immune cells on the corneal endothelium in the PK, DSEK, and DMEK groups, whereas no immune cells were observed in any of the control patients. The numbers of immune cells tended to be higher in regraft eyes in the PK group (P = 0.00221) and in the DSEK group (P = 0.168) than those in the primary graft eyes. No significant association was found between the density of immune cells and corneal endothelial cell density in the PK, DSEK, and DMEK groups.Conclusions: Immune cells were observed to a similar extent in the eyes of PK, DSEK, and DMEK subjects even in the absence of any clinical sign of immune rejection. A further prospective longitudinal study will evaluate the effect of immune cells on long-term graft survival and the risk for graft rejection.

Blut-Kammerwasser-Schranken-Störungen bei perforierender und posteriorer lamellärer Keratoplastik: Implikationen für das klinische Ergebnis

“…Repeat keratoplasty procedures (PKP and posterior lamellar keratoplasty) showed increased cell densities on the endothelium compared to primary keratoplasty procedures, while again there were no differences in flare. From this, the authors concluded that in both cases, the presence of immune cells on the corneal endothelium is not primarily due to BAB damage [20].…”

“…A study by Okumura and colleagues investigated BAB dysfunction as a possible cause of immune cells on the endothelium after keratoplasty (detected with the HRT Rostock Corneal Module) without a recognizable rejection reaction. This study with a comparatively small cohort did not find any significant differences in flare measurements in eyes after PKP (17 eyes, 27.7 ± 31.8 months postop), posterior lamellar keratoplasty [DSEK (13 eyes, 20.3 ± 20.3 months postop)], and DMEK (13 eyes, 11.2 ± 8.4 months postop) compared to controls (26 eyes after cataract surgery), although a trend towards higher flare values was observed in some patients in the PKP group [20]. Neither was there any correlation between the density of the immune cells and the flare.…”

“…Graft failure can occur either in the context of an acute immunological rejection reaction, or, without specific signs of rejection, in the context of chronic accelerated loss of endothelial cell density as gradual graft decompensation. In the latter case, a subclinical immune response may be involved [20].…”

“…Ein Transplantatversagen kann dabei zum einen im Rahmen einer akuten immunologischen Abstoßungsreaktion oder aber ohne konkrete Abstoßungszeichen im Rahmen des chronisch beschleunigten Verlusts der Endothelzelldichte als allmähliche Transplantatdekompensation erfolgen. Bei Letzterer spielt möglicherweise eine subklinische Immunreaktion eine Rolle [20].…”

Risk Factors for Descemet Membrane Endothelial Keratoplasty Rejection: Current Perspectives- Systematic Review

“…They are less commonly available, are challenging to use, and the findings are not very specific to rejection. 60 Their utility comes up when suspecting viral etiologies in these eyes. They can pick up certain particular features like owl’s-eye endothelial cells, which are suggestive of CMV endotheliitis.…”