1 / 12

Sang Yoon Lee 1,2 , Sang- Mok Lee 1,3 , Won Ryang Wee 1,2 ,

Late-onset Stromal Graft Rejection Triggered by Viral Conjunctivitis after Deep lamellar keratoplasty in Keratoconus. Sang Yoon Lee 1,2 , Sang- Mok Lee 1,3 , Won Ryang Wee 1,2 , Jin- Hak Lee 1,2 , Mee Kum Kim 1,2

zeroun
Télécharger la présentation

Sang Yoon Lee 1,2 , Sang- Mok Lee 1,3 , Won Ryang Wee 1,2 ,

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Late-onset Stromal Graft Rejection Triggered by Viral Conjunctivitis after Deep lamellar keratoplasty in Keratoconus Sang Yoon Lee1,2, Sang-Mok Lee1,3, Won Ryang Wee1,2, Jin-Hak Lee1,2, MeeKum Kim1,2 Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute 1 Department of Ophthalmology, Seoul National University College of Medicine2 The armed forces capital hospital, Seoul National University College of Medicine3 The authors have no financial interest

  2. Introduction • Deep anterior lamellar keratoplasty (DALK) • Placing a donor corneal graft within a recipient corneal bed that is prepared with removal of all recipient stromal tissue to Descemet’s membrane • For patients with corneal stromal disease and normal endothelium like keratoconus • Rejection in PKP & DALK • Endothelial rejection occurs in 20% to 30% of patients in PKP • Most graft rejections occur in the first 3 years after keratoplasty • Most frequently over the first 12 months • No endothelial rejection in DALK • Stromal rejection after DALK

  3. Case (M/18) B) Keratoconus • VA (0.5/FC) • Cornea B) bowing, central thinning

  4. L) Deep anterior lamellar keratoplasty done Postop5 months • Vos 0.7, Tos 15 • Cornea : 10o/c new vessel appeared after broken suture developed, but NV regressed after broken suture removed • Ocumetholoneq.i.d, 0.5% cyclosporine b.i.d.

  5. Viral Conjunctivitis episode Postop21 months • Vos (0.6), Tos 18 • Graft : clear • Medication : 0.05% cyclosporine b.i.d. Postop23 months • B) Epidemic keratoconjunctivitis occurred for 2 weeks • Graft : clear • Medication : levofloxacinq.i.d., flumetholoneq.i.d. for 2 weeks Postop 23.5 months • Vos (0.4) • Conjunctiva L) follicular hypertrophy (-), injection (-) • Graft : clear

  6. Later Rejection developed Diffuse stromal infiltration Endothelial edema Previous NV d/t broken suture Postop24 months • C.C. acute visual loss (onset : 2 days ago) • Vos (0.02) • Assessment : L acute rejection • Medication and Treatment • Predforteq1hour • Prednisolone60mg poqd Conjunctival injection

  7. Rejection - regressing Post-rejection 1 week Vos (0.15), Tos11

  8. Rejection - remission Edema, stromal infiltration clear up Subepithelial opacity remained • Post-rejection 11 weeks, Post-PKP 27 months • Vos (0.4), Tos 16-17 • Medication • 0.5% cyclosporine q.d. • Ocumetholoneq.i.d. • He is a steroid responder. That is why we did not use high potency of steroid

  9. Summary New vessel develop and regressed (postop. 5 mo) Steroid treatment Viral conjunctivitis (postop. 23mo) DALK Acute rejection (postop 24mo) Remission (postop 27mo)

  10. Discussion • Rejection in PKP & DALK • A few reports about stromal rejection in DALK • 0%~8% of patients • 16 months~24 months after DALK • Rejection & ocular inflammation • Ocular inflammation is known as a risk factor of rejection in PKP. • Previous report • Herpes keratitis • Allergic conjunctivitis • Atopic dermatitis • Allergic airway hyperreactivitiy • No previous report about viral conjunctivitis

  11. Conclusion • Acute stromal allograft rejection can occur 24 months after DALK. • Viral conjunctivitis seems to be able to trigger stromal graft rejection in DALK, which is known to have less tendency of rejection.

  12. Reference • Flynn, Obbayashi, et al. Effect of allergic conjunctival inflammation on the allogeneic response to donor cornea. Invest Ophthalmol Vis Sci 48(9): 4044-9 • Al-Torbak, Malak, et al. Presumed stromal graft rejection after deep anterior lamellar keratoplasty. Cornea 24(2): 241-3 • Wagoner, Ba-Abbad, et al. Postoperative complications after primary adult optical penetrating keratoplasty: prevalence and impact on the graft survival. Cornea 28(4): 385-94 • Noble, Agrawal, et al. Deep anterior lamellar keratoplasty (DALK): visual outcome and complications for a heterogeneous group of corneal pathologies. Cornea 26(1): 59-64

More Related