Corneal Graft Rejection Risk

Corneal Graft

Corneal transplantation aims to replace all or part of a damaged cornea with a cornea from a donor. In some situations, this procedure can trigger a strong immune response in the recipient, leading to lens clouding and necessitating invasive therapies with regular cortisone administration. Furthermore, current therapies are not always conclusive. Corneal grafting, also called keratoplasty, is used in cases of damaged or non-functional corneas to replace them with a similar healthy element, either synthetic or taken from a recently deceased donor.

Keratoconus is the most common condition requiring corneal transplantation. There are three types of corneal transplantation:

  • Penetrating keratoplasty;
  • Lamellar keratoplasty;
  • Endothelial keratoplasty;

After the operation, the patient must follow certain important medical guidelines to avoid unpleasant complications. A corneal graft can last up to 25 years.

What are the risks of rejection after a corneal graft?

To restore visual function, corneal grafting involves replacing part of the diseased cornea with a donor cornea. It is important to note that unlike other organs which are vascularized, the cornea does not have blood vessels, which greatly reduces the risk of rejection. However, if rejection were to occur, it would only happen 25 days after the operation, as this is the time it takes for the body to identify the foreign tissue and develop antibodies.

The frequency of this tragic event varies and depends on the disease that necessitated the graft. It is a major reaction of the immune system that can lead to severe and, in some cases, irreversible inflammation of the cornea. If not treated promptly, this can lead to corneal opacity and the need for a new graft.

Rejection of the corneal graft is the main reason for failure after surgery. It can be either reversible or irreversible and can affect both full and partial grafts. However, it is less frequent after lamellar grafting.

 

Symptoms and signs of corneal rejection after a graft

What are the symptoms of rejection?

To better understand the signs of rejection, it is important to know the accompanying symptoms. These generally manifest as blurry vision, light sensitivity, and redness of the eye. If these signs appear suddenly and persist or worsen rapidly, it is essential to consult an ophthalmologist immediately. The speed of treatment is crucial to prevent potential damage. The risk of rejection increases when the eye is inflamed.

 

Signs of corneal graft rejection

When a corneal graft is performed, the risk of rejection concerns all the cellular layers of the cornea, such as the epithelium, stroma, or endothelium. However, endothelial rejection is considered the most dangerous, as it jeopardizes the survival of the transplant.

Endothelial rejection is also a concern after posterior lamellar transplantation, although it does not occur after anterior lamellar transplantation.

Some or all of the following signs may be present:

  • Sub-epithelial opacities similar in appearance to adenoviral keratitis;
  • Anterior ciliary injection;
  • Graft edema;
  • Rejection line;
  • Corneal precipitates on the endothelium;

 

EXPRESS QUOTE

Would you like more information?

Votre santé, notre priorité.
Demandez votre devis gratuit






 

What are the risks of corneal grafting?

The main risks associated with corneal grafting besides rejection are divided into risks during the operation and risks after the operation.

Per-operative risks can also be very high in the case of traditional corneal grafting, where the entire cornea is replaced. The eye, in fact, remains open without protection while the patient's cornea is removed and then replaced with the new one.

In these few moments, a serious complication of corneal grafting can occur, called expulsive hemorrhage. Fortunately, this is a rare complication of corneal grafting. This complication is almost absent in lamellar corneal grafting.

In the case of a corneal graft, the main risks to consider are those related to rejection. Although rejection risks always exist during such an operation, it should be noted that this procedure has one of the highest success rates of all organ grafts.

By opting for lamellar grafts, the risk of rejection is considerably reduced, since the amount of transplanted tissue is reduced. Therapy to prevent rejection after corneal grafting is based on corticosteroids, the side effects of which can be cataract or glaucoma formation. With lamellar grafting, the time required for anti-rejection therapy is reduced, which has obvious advantages.

 

What medications are used for rejection therapy after corneal grafting?

To improve the chances of success, it is essential to start anti-rejection treatment quickly after a corneal graft. Previously, this type of treatment relied on the administration of cortisone by subconjunctival injection, accompanied by eye drops and high-dose oral cortisone. This invasive method has a considerable impact on quality of life, especially in the elderly, diabetics, or immunocompromised individuals. Its duration is generally at least one month, or even more. Furthermore, the therapy can cause serious metabolic imbalances, particularly systemic therapy.

 

What are the other possible complications of corneal grafting?

In addition to rejection, corneal grafting can also lead to other complications, such as

  • Astigmatism;
  • Glaucoma;
  • Retinal detachment;
  • Minor reopening of surgical wounds. It must be remembered that corneal repair is very slow, so an injury to the same scar heals very slowly;
  • Infections, especially when surgical wounds are healing;

 

[dt_sc_button title="Free Quote" size="medium" style="bordered" icon_type="" link="url:https%3A%2F%2F127.0.0.1/tds%2Fdevis%2F" textcolor="#ffffff" bgcolor="#0c73ba"]