The effect of immunological and non-immunological factors on corneal graft survival: A single centre study

Völker-Dieben, H. J. M.

doi:10.1007/bf00190461

Cited by 14 publications

(4 citation statements)

References 94 publications

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“…Vast, clinical experience with penetrating keratoplasty collected over more than 50 years indicates that the eye extends immune privilege to corneal grafts [22]. Unlike any other type of solid organ transplant, corneal allografts in humans display a very high rate of acceptance, although immunosuppression is only applied topically and in modest dosage.…”

Section: Foreign Tissue Grafts Survive For Prolonged Often Indefinitmentioning

confidence: 99%

Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation

Streilein

2003

Journal of Leukocyte Biology

302

203

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The delicate visual axis that makes precise vision possible is highly vulnerable to the destructive potential of immunogenic inflammation. Immune privilege of the eye is the experimental expression of the way in which evolution has coped with the countermanding threats to vision of ocular infections and ocular immunity and inflammation. Ocular immune privilege has five primary features that account for its existence: blood:ocular barriers, absent lymphatic drainage pathways, soluble immunomodulatory factors in aqueous humor, immunomodulatory ligands on the surface of ocular parenchymal cells, and indigenous, tolerance-promoting antigen-presenting cells (APCs). Three manifestations of ocular immune privilege that have received the most extensive study are the intraocular microenvironment, which is selectively anti-inflammatory and immunosuppressive; the prolonged acceptance of solid tissue and tumor allografts in the anterior chamber; and the induction of systemic tolerance to eye-derived antigens. Anterior chamber-associated immune deviation is known to arise when indigenous, ocular APCs capture eye-derived antigens and deliver them to the spleen where multicellular clusters of these cells, natural killer T cells, marginal zone B cells, and gammadelta T cells create an antigen-presentation environment that leads to CD4(+) and CD8(+) alpha/beta T cells, which as regulators, suppress induction and expression of T helper cell type 1 (Th1) and Th2 immune expression systems. The ways the eye influences local and systemic immune responses to ocular antigens and pathogens carry risks to and benefits for mammalian organisms. As loss of sight is a powerful, negative-selecting force, the benefits of ocular immune privilege outweigh the risks.

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Section: Foreign Tissue Grafts Survive For Prolonged Often Indefinitmentioning

confidence: 99%

Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation

Streilein

2003

Journal of Leukocyte Biology

302

203

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“…Another reason for the different occurrence of allograft rejection reported may be that cases diagnosed as immune reaction are due to defective donor material or surgical trauma (Barraquer 1985). Volker-Dieben (1984) and Volker-Dieben et al (1984) report that corneal graft rejection is the ultimate determinant of graft survival and the main cause for graft failure. This holds true also for the present material as a whole in the sense main single cause.…”

Section: Risk Groupsmentioning

confidence: 99%

“…therapy (low-risk case: first graft in avascular recipient cornea in patients not suffering from systemic immune disorder). However, several analyses of graftings in high-risk cases, such as patients with vascularized corneal opacities, have revealed better long-term results at good HLA -A,B match than at poor match (Ehlers & Kissmeyer 1979;Volker-Dieben 1984;Volker-Dieben et al 1984, Foulks et al 1982, 1986Hoffmann et al 1986). Thus, a certain requirement for developmen t of new immunosuppressive procedures and for tissue typed corneal discs is evident.…”

mentioning

confidence: 99%

Irreversible immune reactions following keratoplasty

Baun

Gregersen

Prause

1987

Acta Ophthalmologica

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A total of 16/206 eyes in 14/186 patients developed irreversible immune reactions. 15 of the rejected eyes belonged to the 'classical' risk groups, i.e. systemic immune disorders (3/3), metaherpetic keratitis (6/41), pseudophakic bullous keratopathy with inflammation (2/6), non herpetic keratitis with vessel invasion (1/23) and 3 regrafts not included in these groups (a total of 7/31 regrafted eyes rejected). Only 1 rejection occurred in the low-risk groups: an aphakic eye with bullous keratopathy. Histopathological examination revealed that discs which later developed irreversible immune reactions had invariably been grafted in eyes which had vascular invasion and/or inflammation of the recipient cornea. In all, 55/206 eyes ended up with opaque grafts, i.e. irreversible immune reactions were responsible for about one third to one-quarter of the graft failures in the present material. The irreversible immune reactions in the material must be considered 'minimum values', since possible abortive, torpid immune reactions may have escaped recording.

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“…There is a large literature on penetrating keratoplasty, notably regarding the diseases for which it is indicated and the improvement in visual acuity that can be obtained (Andersen & Ehlers 1986;Aquavella et al 1985;Sugar et al 1983;Heidemann et al 1985;Bishop et al 1986;Volker-Dieben 1984;Collum et al 1987). Other aspects, such as the direct comparison of the out-patient work load generated by different groups of patients, have received little attention.…”

mentioning

confidence: 99%

Medical manpower requirements following penetrating keratoplasty for herpes simplex keratitis

Claoué

Falcon

1991

Acta Ophthalmologica

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We have compared the post-operative course of patients requiring penetrating keratoplasty for herpes simplex virus keratitis, keratoconus, and Fuchs' endothelial dystrophy with a minimum of two years follow-up. Although some expected differences (age, sex) were found between these three groups, the number of post-operative clinic visits was not different between the three groups. This is contrary to the common belief that patients requiring penetrating keratoplasty for herpes simplex keratitis are high risk, and will make greater demands on medical resources in the post-operative period. The management of our patients with herpes simplex keratitis is not statistically different from a similar group managed at another centre.

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The effect of immunological and non-immunological factors on corneal graft survival: A single centre study

Cited by 14 publications

References 94 publications

Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation

Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation

Irreversible immune reactions following keratoplasty

Medical manpower requirements following penetrating keratoplasty for herpes simplex keratitis

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