Summary
Our series comprises 80 penetrating grafts. Of the recipient corneas 36 were vascularized. Of the donor corneas 48 were fresh and 32 were cryopreserved. As prophylaxis, we gave topical and systemic prednisolone, combined, in heavily vascularized cases, with azathioprine. Corneal donor-recipient pairs were divided into three groups according to HLA histocompatibility. In Group I (0–1 mismatch) the rate of allograft reaction was 1 in 27, in Group II (2–4 mismatches) it was 4 in 19, and in the untyped Group III 9 in 34. Even when the prognosis was poor, a well-matched donor cornea (Group I) greatly improved the chances of success; when the corneal bed was vascularized, the well-matched donor corneas had a failure rate of 1 in 13, whereas in untyped pairs it was 7 in 18. The importance of possible presensitization is discussed.
Zusammenfassung
Das Untersuchungsmaterial umfaßt 80 Augen nach penetrierender Keratoplastik. In 36 Fällen fand sich die Empfängerhornhaut vaskularisiert und in 44 avaskulär. 48 der Spenderhornhäute waren frisch und 32 eingefroren. Prophylaktisch wurde Prednisolon lokal und systematisch kombiniert mit azathioprine in stark vaskularisierten Fällen verabreicht. Die Spender-Empfänger-Paare wurden gemäß ihrer Histokompatibilität in drei Gruppen eingeteilt. Bei bester Übereinstimmung war das Verhältnis der Allograftreaktion 1 zu 27, in Gruppe II mit 2–4 fremden Antigenen war sie 4 zu 19 und in Gruppe III ohne Bestimmung der HLA-Antigene war sie 9 zu 34. Spenderhornhaut mit guter Übereinstimmung, d.h. 0–1 fremdem Antigen scheint recht zuverlässig auch in Fällen mit schlechter Prognose. In vaskularisierter Empfänger-Hornhaut und Spender mit guter Übereinstimmung war das Verhältnis der mißlungenen Transplantationen 1 zu 13 und bei nicht typisierten Paaren 7 zu 18. Die Rolle einer Präsensibilisierung wird diskutiert.
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Vannas, S., Karjalainen, K., Ruusuvaara, P. et al. HLA-compatible donor cornea for prevention of allograft reaction. Albrecht von Graefes Arch. Klin. Ophthalmol. 198, 217–222 (1976). https://doi.org/10.1007/BF00410714
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DOI: https://doi.org/10.1007/BF00410714