冲击量甲基强的松龙治疗重症角膜移植排斥反应6例

目的观察冲击量甲基强的松龙治疗重症角膜移植排斥反应的临床疗效。方法重症角膜移植排斥反应病例6例,采用甲基强的松龙500mg一次性静脉滴注,然后给予维持量皮质激素治疗。结果5例治愈,随访观察2a余,角膜植片保持透明;1例好转,随访观察1a,移植片基本透明,但仍有轻度水肿。结论重症角膜移植排斥反应可以采用冲击量甲基强的松龙治疗。     

穿透性角膜移植术后排斥反应的治疗

局部及全身应用地塞米松治疗穿透性角膜移植术后排斥反应２４例３２眼，术前角膜无血管的排斥反应治愈率达８０％，平均治愈天数为９．６天，术前角膜有血管的排斥反应治愈率达到５５．６％，平均治愈天数为１５．２天，总治愈率为５９．３％，总治愈天数１２．４天。地塞米松局部结合全身治疗排斥反应可以缩短治愈天数，提高治愈率，是一种较好的治疗方案。     

角膜移植术后角膜免疫排斥反应的临床探讨

目的 探讨角膜移植术后角膜免疫排斥反应的有效防治方法。方法 对穿透角膜移植术后发生角膜免疫排斥反应的68例(68眼)进行回顾性总结。 结果 经统计学分析结果表明:角膜化学烧伤、角膜新生血管、大植片移植、术前活动性角膜炎症、再次移植等均为穿透角膜移植术后免疫排斥反应的主要因素。 结论 免疫排斥反应的发生与术前高危角膜移植有着非常密切的关系。     

角膜移植术后排斥反应的防治探讨

目的:为控制角膜移植术后发生排斥反应,探讨防治排斥反应的有效途径。方法:对73例73眼穿透性角膜移植术患者术后排斥反应发生率进行回顾性分析。结果:患者73眼中28眼发生免疫排斥反应(38%),其中高危角膜病变21眼,非高危角膜病变7眼,有角膜新生血管者占88%,排斥反应发生时间为术后2wk～3a,以内皮型排斥反应为主(43%)。经药物联合治疗,角膜排斥反应得到明显抑制,有效率达61%。结论:高危角膜病变免疫排斥反应几率明显增加,发生时间及持续时间较长,因此应根据不同角膜病变在术前、术中、术后采取相应措施减少排斥反应发生率。     

穿透角膜移植发生排斥反应后再行角膜移植

穿透角膜移植发生排斥反应后再行角膜移植广州南方医院魏湛云，张淑红，林瑞杰本文介绍我院９３年收治的４例穿透性角移术后发生排斥反应后再移植病例，并对治疗的若干问题进行讨论。例１男２４岁左眼氨水烧伤两年，遗留角膜白斑。左眼视力０．０８，角膜呈灰白色，全层角...     

角膜移植术后免疫排斥反应临床研究

确立角膜移植术后免疫排斥反应的有效防治策略。方法对穿透性角膜移植术后发生免疫排斥反应的８６例进行回顾性总结。结论从分子水平减少供受体间的抗原差异,研制新一代高效安全的免疫抑制剂,创造免疫耐度的理论环境可能是控制高角角膜移植免疫排斥反应的有效措施。     

穿透角膜移植术后植片的免疫排斥反应

本文对角膜移植术后免疫排斥反应的发生率,危险因素,临床表现,以及发生机制和治疗一综述。     

角膜移植术后免疫排斥反应的探讨

目的：为有效控制角膜移植术后免疫排斥反应的发生，探讨角膜移植术后免疫排斥反应发生的因素。方法：对角膜手术后发生排斥反应者进行分析，总结发生的原因、时间，程度等，结果：123眼中发生免疫排斥反应46眼（37．4％），其中17眼发生不可逆的排斥反应，占排斥反应的36．96％；有角膜新生血管发生排斥反应41眼，占89．13％，内皮型排斥反应20眼，上皮型12眼，基质型3眼，混合型11眼，排斥反应发生时间为术后3周－3年，术后3－6月发生率最高，占46．48％，结论：免疫排斥反应的发生是多因素参与的复杂过程，与角膜新生血管的数量，角膜受损及感染的程度，植片的大小，手术的次数以及手术的时机和方式密切相关。     

全角膜移植术后免疫排斥反应的探讨

目的：评价对严重全角膜病变行带环形板层巩膜瓣全角膜移植术（CST）后免疫排斥反应的临床疗效。方法：对用药无法控制的严重全角膜病变患者10例进行回顾性研究，其中化脓性角膜溃疡9例，大泡性角膜病变伴全角膜白斑1例，全部病人均行CST。结果：随访1-23个月，平均10.2个月，10例视力均有不同程度提高；8例植片透明，2例植片半透明；5例术后3-4个月出现角膜新生血管（其中2例植片半透明）；2例术后半年出现免疫排斥反应。结论：CST是治疗严重角膜病变的有效方法，不但挽救眼球且能恢复一定的视力。     

高危角膜移植术后免疫排斥反应规律的临床研究

目的 探讨不同病因的高危移植患者行穿透性角膜移植术后免疫排斥反应发生的规律。方法 对６８０例行穿透性角膜移植术中的１２４例１３４只眼高危移植患者术后排斥反应时间、排斥反应发生率及反应类型进行观察。结果 １３４只眼高危角膜移植术后免疫排斥反应发生率在１２％～７５％不等,其中角膜植床严重新生血管化者的排斥率最高。排斥发生时间最早为术后１３天,术后３～６个月为排斥反应发生高峰。排斥反应类型以内皮型和上皮型最多。结论 不同高危因素的穿透性角膜移植术后排斥反应发生率不同,排斥反应发生的时间和类型也不同。     

Graft failure IV. Immunologic mechanisms of corneal transplant rejection

Corneal transplantation is the oldest and the most common form of solid tissue transplantation in humans. Immunologic graft rejection is one of the main causes of short and long-term graft failure. Rejection involves donor tissue recognition and destruction by allo-specific immune cells of the recipient. This review outlines (1) the immunobiology of transplantation, with reference to ocular immune privilege, (2) factors that confer “high-risk” status to a graft and (3) the pathophysiologic mechanisms of corneal transplant rejection.     

A case of acute endothelial corneal transplant rejection following immunization with ChAdOx1 nCoV-19 coronavirus vaccine

A 28-year-old female who underwent an uneventful femtosecond laser enabled keratoplasty (FLEK) in her left eye presented with pain, redness, and blurring of vision in the operated eye two weeks after getting immunized with COVID-19 vector vaccine (ChAdOx1 nCoV19 Vaccine Recombinant COVISHIELD, AstraZeneca). Slit-lamp examination showed donor stromal edema with Descemet’s membrane folds and Khodadoust line (KP’s on endothelium) with anterior chamber cells and flare. The patient was diagnosed with acute corneal graft rejection and advised hourly topical steroids with cycloplegics and oral steroids. The patient responded to treatment and there was progressive reversal of graft rejection with the patient achieving best spectacle-corrected visual acuity (BSCVA) of 20/30 after five weeks of treatment. Our case highlights possible immune corneal graft rejection after COVID19 vaccination and the need to step up topical steroids before vaccination.     

Pharmacologic strategies in the prevention and treatment of corneal transplant rejection

Corneal transplantation remains one of the most successful organ transplantation procedures in humans. The unique structure of the cornea, with its absence of blood vessels and corneal lymphatic, allows the survival of corneal allograft. Recent advances in sutures, storage media, microsurgical instrumentation, and new pharmacological strategies have greatly improved the success of corneal transplantation and the prevention of corneal allograft rejection. Our strategies in the management and prevention of corneal graft rejection can modify and improve the survival of corneal allografts. Preoperative evaluation, understanding the risk factors, and management of ocular surface disorders may greatly improve the survival of the corneal transplant. Early recognition of corneal allograft rejection and aggressive treatment may improve the survival of the corneal graft. Furthermore, patients who undergo corneal transplantation should be maintained under close ophthalmic surveillance and patients should be informed to report immediately whenever symptoms of corneal graft rejection occur. The mainstay of therapy is topical corticosteroids. In severe cases, periocular, intravenous, and oral corticosteroids therapy can be rendered. New therapeutic modalities such as cyclosporine, tacrolimus, daclizumab, mycophenolate mofetil, leflunomide, rapamycin, and others may prove to be of help in the prevention and treatment of corneal graft rejection. Early recognition of corneal graft rejection and prompt treatment are mandatory for the successful survival of the corneal allograft.     

角膜移植术后免疫排斥反应的防治

目的 为控制角膜移植术后发生排斥反应，探讨防治排斥反应的有效途径。方法 根据不同角膜病变排斥反应发生的规律给予不同期的药物联合治疗，降低和控制排斥反应。结果 129眼中47眼(36．43％)发生免疫排斥反应，其中高危角膜病变40眼，非高危角膜病变7眼。有角膜新生血管者占89．36％。排斥反应发生时间为术后3周—3年。经药物联合治疗，角膜排斥反应得到明显的抑制，有效率达63．83％。结论 免疫排斥反应的发生是多因素参与的复杂过程，尤其高危角膜病变，术后出现排斥反应的机率明显增加，发生的时间相对较早，时间跨度较长。因此应根据不同的角膜病变及手术情况，尽早应用免疫抑制剂可明显降低排斥反应的发生率。     

甲基强的松龙冲击疗法治疗病情反复严重的原田综合征

目的 评介甲基强的松龙冲击疗法（简称甲冲法）治疗病情反复严重的原田综合征的疗效。方法 从病情反复的严重原田综合征中选择一般疗法无效,又无肾上腺皮腩激素禁忌的病例20例（40眼）为研究对象,甲冲法是用甲基强的松龙500－1000mg加入5％葡萄糖溶液500ml静脉滴注,每天1次,3－5天为一疗程。以后再用一般疗法。结果 显效（视力提高6排以上）14例（28眼）,占70％眼;有效（视力提高3－5排）4例（8眼）,占20％眼;总有效率为90％,无效（视力＜0.1）2例（4眼）,占10％眼,未发现副作用,随访10个月－1年无复发。结论 甲冲法治疗病情反复严重的原田综合征,作用迅速可靠,疗效高,未发现副作用,随访无复发。     

角膜共焦显微镜早期诊断兔高危角膜移植排斥反应的价值

目的:角膜共焦显微镜检查对兔碱烧伤角膜移植排斥反应进行研究,找寻排斥反应早期诊断的客观指标。方法:制作兔角膜碱烧伤模型,36d后行穿透性角膜移植,于角膜移植术后4,9,14,21~28d诊断排斥反应时,角膜共焦显微镜检查角膜。结果:排斥反应时角膜共焦显微镜检查见角膜植片炎性细胞浸润,角膜细胞丢失,新生血管生长。结论:角膜共焦检查有助于早期诊断排斥反应。     

应用生物羊膜填塞缝合固定术治疗偏中心角膜穿孔

目的探讨生物羊膜填塞缝合固定术治疗偏中心角膜穿孔的疗效。方法应用生物羊膜制作成羊膜塞,对9例偏中心角膜穿孔患者行羊膜填塞缝合固定联合羊膜覆盖术治疗。其中,真菌性角膜溃疡穿孔2例,陈旧性病毒性角膜炎角膜白斑穿孔4例,角膜异物取出术后穿孔3例。结果9眼术后早期无羊膜塞脱出或脱入前房,覆盖的羊膜移植片透明完整,未见溶解和脱落,真菌性角膜溃疡者术后7～10天炎症控制稳定,溃疡消失,角膜穿孔愈合,前房形成。4周内均形成完好的角膜上皮覆盖,羊膜塞与周边角膜组织愈合良好。术后三个月随访显示,羊膜塞位置正常,无排斥或向前房内脱落,穿孔瘢痕愈合形成角膜翳,角膜透明度正常。视力由术前的0.02-0.1提高到0.5-1.0。验光检查:-0.25±0.47D。结论生物羊膜填塞缝合固定术治疗角膜穿孔是一种取材容易,操作简单,行之有效的治疗方法。     

重视角膜移植术后免疫排斥反应的防治

角膜移植术是角膜病盲人复明的最主要手段,但术后的免疫排斥反应仍是手术失败的最主要原因.随着我国医疗水平的不断提高,开展角膜移植手术的医院也不断增加.而如何减少术后的并发症和提高植片的长期透明率,是摆在众多从事角膜移植医师面前的一个重要问题.保持角膜移植术后植片长期透明的核心问题是重视术后随诊和免疫排斥反应的防治.本文主要从我国角膜移植的现状、存在的问题及如何减少免疫排斥反应的措施三个主要方面进行分析,并对目前角膜移植术后存在的一些普遍问题提出相应的处理措施和建议,以达到减少角膜移植术后由免疫排斥反应导致植片混浊的再次致盲问题.     

Outcome of corneal transplant rejection: a 10-year study

PURPOSE: To study the incidence of graft rejection and the predictive factors for its reversibility. METHODS: It is a retrospective study of 1927 consecutive penetrating keratoplasties performed between January 1990 and January 2000 with more than 6 months follow up. A total of 224 rejection episodes were noted in 183 patients. Of these, 184 first rejection episodes were included in this study. RESULTS: The incidence of first rejection episode was 9.55%. Of patients 87% were symptomatic during the episode with vision loss being the commonest. The average time of onset of rejection was 15.25 +/- 14.4 months (median 11.7 months). In total, 53.3% of rejections occurred within 1 year after surgery. Of the patients who completed minimum 3 months follow up after the rejection episode, the rate of reversibility was 63.3%. Major predictive factors for a poor outcome after rejection were repeated grafting and associated anterior vitrectomy during surgery. The reversibility of the episode did not differ significantly with the modality of treatment used, but treatment with intravenous steroids within 7 days of onset of rejection may have a role in reducing the recurrences of rejection episodes, thus increasing the graft survival. CONCLUSION: Regrafts and associated anterior vitrectomy were significant risk factors for a poor outcome following rejection episode.