The Clinical Study Of Graft Rejection High Risk Factors In Keratoplasty

Objective:To discuss the risk factors of corneal allograft rejection, and to effectivecontrol the occurrence of corneal allograft rejection.Methods:Retrospective analyzed the data of the patients who had cornealgraft rejection，to summarized the etiological factor, period and proportion, etc.Result:In this study，we retrospective summarized the data from289eyes of275patients who had the corneal graft rejection. The whole rejection incidence is26.64%(77/289).Among them, corneal leukoma is17.6%(25/142)，consisted ofadherent leucoma20.7%(17/82), simple leucoma13.3%(8/60);cornealulcer is37.9%(25/66),consisted of Mycotic corneal ulcer38.1%(16/42),viral corneal ulcers30%(6/20)，Mooren ulcer75%(3/4);bullous Keratopathy is41.67%(15/36); keratinous is19%(4/21);refractoriness pterygium is25%(2/8);corneal、conjunctival chemical injury are100%(3/3); corneal degeneration is33.3%(2/6); corneal dystrophy is16.67%(1/6) and corneal staphyloma one casewithout any rejection occurred after the surgery (0/1). In this study, the cornealgraft rejection occurred between15days to3years after corneal grafting, thecrest-time of reaction is happened on1month、5months,1year and a half afterthe surgery. After clinical treatment, finally10eyes’ grafts edema weren’tameliorated, which account for12.99%of the whole rejection cases. Cornealchemical injury caused the highest rejection rate, followed by Mooren ulcer,bullous Keratopathy and fungal corneal ulcer. By contrast，Simple leukoma, corneal dystrophy, corneal staphyloma had lower incidence. In this study，majority type of rejection were epithelium and endothelium rejection, nohyperacute rejection happened. More corneal neovascularization before thesurgery would cause a higher rejection incidence. According to our statistics, afterroutine corneal grafting，the rejection incidence is only10%in the cases withoutcorneal neovascularization, while the rate reach up to more than60%during thecases who had severe preoperative neovascularization. Preoperative anteriorchamber inflammation and oboslete iridocyclitis are causes of subacute rejection.In our study，the incidence is24.67%in the cases without anterior、posteriorsynechia，33.9%in the cases who had anterior、posterior synechia. Compared withnormal eyes. Aphakia and pseudophakic eyes had a higher rejection incidence.Aphakia cases’ rejection incidence is43.75%, phakic cases’ incidence is25.64%.The incidence is significant higher in Aphakia than phakic eyes.Penetrating keratoplasty (PK) rejection incidence is higher than lamellarkeratoplasty, and among them, corneal endothelial transplantation has the lowestrejection incidence. As the receptors’ original cornea diseases were diversities, thelesion’s location, size were different. To match the recipient beds’ individualdifferences on size and shape, the grafts were different too. But the grafts’ size hada close relationship with postoperative rejection. Larger diameter grafts wouldhave a higher rejection occurrence probability. In our study, some rejectionshappened for self drug withdrawal. And some patients can not be diagnosis andreceive treatment timely, which lead to the grafts obviously turbidity and theendothelial function decompensation heavily, resulting in the corneal graftscompletely turbidity finally. Through this study we could draw the conclusion thatthe happen of corneal graft rejection has closely relative with the high risk factors.Conclusion:1、In this study，we found corneal chemical injury and Mooren ulcer, followed by fungal keratitis had the highest corneal graft rejectionincidence.2、The formation of corneal neovascularization, anterior、posteriorsynechia，preoperative or postoperative high intraocular pressure(IOP),aphakia, variety of joint surgery, large size of the graft are the high riskfactors of corneal allograft rejection.3、Corneal leukoma is the most common reason to have the cornealgrafting in our hospital followed by infectively corneal disease such ascorneal ulcers.