RSS-Feed abonnieren
DOI: 10.1055/s-2005-858853
© Georg Thieme Verlag KG Stuttgart · New York
Differenzialdiagnose und Therapie der Transplantatabstoßung nach Keratoplastik
Differential Diagnosis and Therapy of Allograft Rejection after KeratoplastyPublikationsverlauf
Eingegangen: 5.9.2005
Angenommen: 21.10.2005
Publikationsdatum:
25. November 2005 (online)
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
- 2 Arentsen J J. Corneal transplant allograft reaction: possible predisposing factors. Trans Am Ophthalmol Soc. 1983; 222 361-402
- 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
- 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
- 5 Bertelmann E, Pleyer U. Immunomodulatory therapy in ophthalmology - Is there a place for topical application?. Ophthalmologica. 2004; 222 359-367
- 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
- 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
- 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
- 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
- 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
- 11 Hill J C, Ivey A. Corticosteroids in corneal graft rejection: double versus single pulse therapy. Cornea. 1994; 222 383-388
- 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
- 13 Hirst L W, Stark W J. Clinical specular microscopy of corneal endothelial rejection. Arch Ophthalmol. 1983; 222 1387-1391
- 14 Hoffmann F, Wiederholt M. Topical cyclosporin A in the treatment of corneal graft reaction. Cornea. 1986; 222 129
- 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
- 16 Khodadoust A A, Silverstein A M. Transplantation and rejection of individual cell layers of the cornea. Invest Ophthalmol. 1969; 222 180-195
- 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
- 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
- 19 Krachmer J H, Alldredge O C. Subepithelial infiltrates: a probable sign of corneal transplant rejection. Arch Ophthalmol. 1978; 222 2234-2237
- 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
- 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
- 22 Opelz G. Effect of the maintenance immunosuppressive drug regimen on kidney transplant outcome. Transplantation. 1994; 222 443-446
- 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
- 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
- 25 Pleyer U, Ritter T. Gene therapy in immune mediated diseases of the eye. Prog Retin Eye Res. 2003; 222 277-293
- 26 Pleyer U, Bertelmann E, Rieck P. et al . Outcome of penetrating keratoplasty in rheumatoid arthritis. Ophthalmologica. 2002; 222 249-255
- 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
- 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
- 29 Pleyer U, Weidle E G, Lisch W. et al . Klinische Verlaufsformen immunologischer Transplantatreaktionen nach perforierender Keratoplastik. Fortschr Ophthalmol. 1990; 222 14-19
- 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
- 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
- 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
- 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
- 34 Rinne J R, Stulting R D. Current practice in the prevention and treatment of corneal allograft rejection. Cornea. 1992; 222 326-332
- 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
- 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
- 37 Ruusuvaara P. Histocompatibility and corneal graft endothelium. Acta Ophthalmol. 1979; 222 968-981
- 38 Severin M. Immunreaktionen nach Keratoplastik. Klin Mbl Augenheilk. 1986; 222 200-208
- 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
- 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
- 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
- 42 Wachtlin J, Khaireddin R, Hoffmann F. Tissue typing in perforating corneal transplantation. Ophthalmologe. 2003; 222 1021-1030
- 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
- 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
- 45 Zirm E. Eine erfolgreiche totale Keratoplastik. Albrecht von Graefes Arch Ophthalmol. 1906; 222 580-593
Prof. Dr. med. U. Pleyer
Augenklinik, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum
Augustenburger Platz 1
13353 Berlin
Telefon: ++ 49/30/4 50-55 41 31
Fax: ++ 49/30/4 50-55 49 01
eMail: uwe.pleyer@charite.de