Download PDF
Klin Monbl Augenheilkd 2005; 222(11): 863-869
DOI: 10.1055/s-2005-858853
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Differenzialdiagnose und Therapie der Transplantatabstoßung nach Keratoplastik

Differential Diagnosis and Therapy of Allograft Rejection after KeratoplastyU. Pleyer1 , E. Bertelmann1
  • 1Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin
Further Information

Publication History

Eingegangen: 5.9.2005

Angenommen: 21.10.2005

Publication Date:
25 November 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Immunmediierte Abstoßungsreaktionen sind Hauptursache des Transplantatversagens nach perforierender Keratoplastik. Klinisch können sie sich isoliert oder auch kombiniert als akut auftretende Veränderung am Empfängerepithel, -stroma oder -endothel manifestieren. Die Differenzierung von anderen morphologischen Veränderungen im postoperativen Verlauf nach Hornhauttransplantation kann sich schwierig gestalten, hat für die Therapie jedoch unmittelbare Bedeutung. Der vorliegende Beitrag soll die wichtigsten Differenzialdiagnosen und therapeutischen Maßnahmen zusammenfassend darstellen.

Abstract

Allograft rejection is the leading cause of corneal graft failure after perforating keratoplasty. Clinically, graft rejection may present as acute changes in corneal host tissue. All three corneal layers, epithelium, stroma and endothelium, can be affected separately or manifest combinations of rejection. Differentiation from other postoperative morphological changes following corneal transplantation can prove to be difficult, but is critical in treatment. This article is intended to provide a review on differential diagnoses and current therapeutic measures.

Schlüsselwörter

Hornhaut - Keratitis - Therapie - Transplantatabstoßung

Key words

Cornea - keratitis - therapy - allograft rejection

Literatur

  • 1 Alldredge O C, Krachmer J H. Clinical types of corneal transplant rejection. Their manifestations, frequency, preoperative correlates and treatment.  Arch Ophthalmol. 1981;  222 599-604
    PubMedGoogle Scholar
  • 2 Arentsen J J. Corneal transplant allograft reaction: possible predisposing factors.  Trans Am Ophthalmol Soc. 1983;  222 361-402
    PubMedGoogle Scholar
  • 3 Bertelmann E, Hartmann C, Scherer M. et al . Outcome of rotational keratoplasty: Comparison of endothelial cell loss in autografts versus allografts.  Arch Ophthalmol. 2004;  222 1437-1440
    PubMedGoogle Scholar
  • 4 Bertelmann E, Knapp S, Rieck P. et al . Transkornealer-parakornealer Penetrationsweg für lokal applizierte Pharmaka am Auge: Mycophenolat Mofetil als Modellsubstanz.  Ophthalmologe. 2003;  222 696-701
    PubMedGoogle Scholar
  • 5 Bertelmann E, Pleyer U. Immunomodulatory therapy in ophthalmology - Is there a place for topical application?.  Ophthalmologica. 2004;  222 359-367
    PubMedGoogle Scholar
  • 6 Bertelmann E, Reinhard T, Pleyer U. Stand der Immunprophylaxe und -therapie bei perforierender Keratoplastik. Eine Umfrage bei Mitgliedern der Sektion Kornea der DOG.  Ophthalmologe. 2003;  222 1031-1035
    PubMedGoogle Scholar
  • 7 Bertelmann E, Ritter T, Vogt K. et al . Efficiency of cytokine gene transfer in corneal endothelial cells and organ cultured corneas by liposomal vehicles and recombinant adenovirus.  Ophthalmic Res. 2003;  222 117-124
    PubMedGoogle Scholar
  • 8 Birnbaum F, Reinhard T, Böhringer D. et al . Endothelial cell loss after autologous rotational keratoplasty.  Graefes Arch Clin Exp Ophthalmol. 2005;  222 57-59
    PubMedGoogle Scholar
  • 9 Coster D J, Muehlberg S M, Bartlett C M. et al . Report from the Australian Corneal Graft Registry 1999.  Snap Printing: Adelaide. 2000;  1-137
    PubMedGoogle Scholar
  • 10 Coster D J, Williams K A. Immunomodulation for corneal transplantation. Pleyer U, Mondino BJ Essentials in Ophthalmology. Uveitis and Immunological Disorders Heidelberg/Berlin; Springer 2004: 35-50
    Google Scholar
  • 11 Hill J C, Ivey A. Corticosteroids in corneal graft rejection: double versus single pulse therapy.  Cornea. 1994;  222 383-388
    PubMedGoogle Scholar
  • 12 Hill J C, Maske R, Watson P G. The use of a single pulse of intravenous methylprednisolone in the treatment of corneal graft rejection. A preliminary report.  Eye. 1991;  222 420-424
    PubMedGoogle Scholar
  • 13 Hirst L W, Stark W J. Clinical specular microscopy of corneal endothelial rejection.  Arch Ophthalmol. 1983;  222 1387-1391
    PubMedGoogle Scholar
  • 14 Hoffmann F, Wiederholt M. Topical cyclosporin A in the treatment of corneal graft reaction.  Cornea. 1986;  222 129
    PubMedGoogle Scholar
  • 15 Hudde T, Minassian D C, Larkin D FP. Randomised controlled trial of corticosteroid regimens in endothelial corneal allograft rejection.  Br J Ophthalmol. 1999;  222 1348-1352
    PubMedGoogle Scholar
  • 16 Khodadoust A A, Silverstein A M. Transplantation and rejection of individual cell layers of the cornea.  Invest Ophthalmol. 1969;  222 180-195
    PubMedGoogle Scholar
  • 17 Knapp S, Bertelmann E, Hartmann C. et al . Intraocular availability of topically applied Mycophenolate mofetil in rabbits.  J Ocul Pharmacol Ther. 2003;  222 181-192
    PubMedGoogle Scholar
  • 18 Koay P Y, Lee W H, Figueiredo F C. Opinions on risk factors and management of corneal graft rejection in the United kingdom.  Cornea. 2005;  222 292-296
    PubMedGoogle Scholar
  • 19 Krachmer J H, Alldredge O C. Subepithelial infiltrates: a probable sign of corneal transplant rejection.  Arch Ophthalmol. 1978;  222 2234-2237
    PubMedGoogle Scholar
  • 20 Mayer D J, Daar A S, Casey T A. et al . Localization of HLA-A, B, C and HLA-DR antigens in the human cornea: practical significance for grafting technique and HLA typing.  Transplant Proc. 1983;  222 126-129
    PubMedGoogle Scholar
  • 21 Musch D C, Schwartz A E, Fitzgerald-Shelton K. et al . The effect of allograft rejection after penetrating keratoplasty on central endothelial cell density.  Am J Ophthalmol. 1991;  222 739-742
    PubMedGoogle Scholar
  • 22 Opelz G. Effect of the maintenance immunosuppressive drug regimen on kidney transplant outcome.  Transplantation. 1994;  222 443-446
    PubMedGoogle Scholar
  • 23 Oral H B, Larkin D F, Fehervari Z. et al . Ex vivo adenovirus-mediated gene transfer and immunomodulatory protein production in human cornea.  Gene Ther. 1997;  222 639-647
    PubMedGoogle Scholar
  • 24 Patel S V, Hodge D O, Bourne W M. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty.  Am J Ophthalmol. 2005;  222 311-319
    PubMedGoogle Scholar
  • 25 Pleyer U, Ritter T. Gene therapy in immune mediated diseases of the eye.  Prog Retin Eye Res. 2003;  222 277-293
    PubMedGoogle Scholar
  • 26 Pleyer U, Bertelmann E, Rieck P. et al . Outcome of penetrating keratoplasty in rheumatoid arthritis.  Ophthalmologica. 2002;  222 249-255
    PubMedGoogle Scholar
  • 27 Pleyer U, Groth D, Hinz B. et al . Efficiency and toxicity of liposome-mediated gene transfer to corneal endothelial cells.  Exp Eye Res. 2001;  222 1-7
    PubMedGoogle Scholar
  • 28 Pleyer U, Steuhl K P, Weidle E G. et al . Corneal graft rejection: Incidence, manifestation, and interaction of clinical subtypes.  Transplant Proc. 1992;  222 2034-2037
    PubMedGoogle Scholar
  • 29 Pleyer U, Weidle E G, Lisch W. et al . Klinische Verlaufsformen immunologischer Transplantatreaktionen nach perforierender Keratoplastik.  Fortschr Ophthalmol. 1990;  222 14-19
    PubMedGoogle Scholar
  • 30 Reinhard T, Sundmacher R. Adjunctive intracameral application of corticosteroids in patients with endothelial immune reactions after penetrating keratoplasty: a pilot study.  Transpl Int. 2002;  222 81-88
    PubMedGoogle Scholar
  • 31 Reinhard T, Böhringer D, Enczmann J. et al . HLA class I/II matching and chronic endothelial cell loss in penetrating normal risk keratoplasty.  Acta Ophthalmol Scand. 2004;  222 13-18
    PubMedGoogle Scholar
  • 32 Reinhard T, Mayweg S, Reis A. et al . Topical FK506 as immunoprophylaxis after allogeneic penetrating normal-risk keratoplasty: a randomized clinical pilot study.  Transpl Int. 2005;  222 193-197
    PubMedGoogle Scholar
  • 33 Reis A, Reinhard T, Voiculescu A. Effect of mycophenolate mofetil versus Cyclosporin A in high-risk keratoplasty patients: a prospective clinical trial.  Br J Ophthalmol. 1999;  222 1268-1271
    PubMedGoogle Scholar
  • 34 Rinne J R, Stulting R D. Current practice in the prevention and treatment of corneal allograft rejection.  Cornea. 1992;  222 326-332
    PubMedGoogle Scholar
  • 35 Ritter T, Gong N, Pleyer U. Is ex vivo adenovirus mediated gene transfer a therapeutic option for the treatment of corneal diseases?.  Br J Ophthalmol. 2005;  222 648-649
    PubMedGoogle Scholar
  • 36 Robert P Y, Liekfeld A, Metzner S. et al . Specific antibody production in herpes keratitis: intraocular inflammation and corneal neovascularisation as predicting factors.  Graefes Arch Clin Exp Ophthalmol. 2005;  222 1-6
    PubMedGoogle Scholar
  • 37 Ruusuvaara P. Histocompatibility and corneal graft endothelium.  Acta Ophthalmol. 1979;  222 968-981
    PubMedGoogle Scholar
  • 38 Severin M. Immunreaktionen nach Keratoplastik.  Klin Mbl Augenheilk. 1986;  222 200-208
    PubMedGoogle Scholar
  • 39 Sloper C M, Powell R J, Dua H S. Tacrolimus (FK506) in the management of high-risk corneal and limbal grafts.  Ophthalmology. 2001;  222 1838-1844
    PubMedGoogle Scholar
  • 40 Vail A, Gore S M, Bradley B A. et al . Clinical and surgical factors influencing corneal graft survival, visual acuity and astigmatism.  Ophthalmology. 1996;  222 41-49
    PubMedGoogle Scholar
  • 41 van Rooij J, Rijneveld W J, Remeijer L. et al . Effect of oral acyclovir after penetrating keratoplasty for herpetic keratitis: a placebo-controlled multicenter trial.  Ophthalmology. 2003;  222 1916-1919
    PubMedGoogle Scholar
  • 42 Wachtlin J, Khaireddin R, Hoffmann F. Tissue typing in perforating corneal transplantation.  Ophthalmologe. 2003;  222 1021-1030
    PubMedGoogle Scholar
  • 43 Yamagami S, Dana M R. The critical role of lymph nodes in corneal alloimmunization and graft rejection.  Invest Ophthalmol Vis Sci. 2001;  222 1293-1298
    PubMedGoogle Scholar
  • 44 Zhang E P, Schulte F, Bulfone-Paus S. et al . The effect of corticosteroid and cyclosporin A on murine corneal allograft rejection.  Graefes Arch Clin Exp Ophthalmol. 2000;  222 525-530
    PubMedGoogle Scholar
  • 45 Zirm E. Eine erfolgreiche totale Keratoplastik.  Albrecht von Graefes Arch Ophthalmol. 1906;  222 580-593
    PubMedGoogle Scholar

Prof. Dr. med. U. Pleyer

Augenklinik, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum

Augustenburger Platz 1

13353 Berlin

Phone: ++ 49/30/4 50-55 41 31

Fax: ++ 49/30/4 50-55 49 01

Email: uwe.pleyer@charite.de

      >