Observe The Different Types Of Endothelial Corneal Allograft Rejection By Laser Scanning Confocal Microscopy

Purpose: Compared the relationship between two types of endothelium rejectionwith the primary disease, plant size and postoperative time. To observe the changefeature of two types (localized and diffuse) of endothelial corneal allograft rejectionwith different clinical course by Laser Scanning Confocal Microscope, and make aanalysis of the difference between two types of endothelial corneal allograft rejectioncombine with clinical manifestations.Methods:144patient(s144eyes)with endothelial corneal allograft rejection whohad receive treatment in Shandong Eye Hospital were collected. These patients weredivided into two types, localized type and diffuse type, depending on whether there isa Khodadoust’s line. The localized type include64case(s64eyes)and the diffuse typeinclude80cases(80eyes). All patients received anti-rejection treatment. Collectedinformation of primary disease, plant size and postoperative time of all patients.Observed ciliary hyperemia, Khodadoust’s line and KP with slit lamp. Add up thecorrected visual acuity. Laser scanning confocal microscopy was used to observemorphological changes of each layer of corneal cells and KP in edematous area oflocalized type, transparent area of localized type and diffuse type before and aftertreatment. Quantity and activation of dendritic cells in epithelial basement membrane, amount of endothelial cell had been recorded. Calculate the endothelial cell loss rateof two types of rejection. All data of patients had been recorded with a follow-up visitof one year.Result: The highest rate of primary disease in diffuse type were ocular burns,fungal corneal ulcer and HSK in order, localized type were leukoma，keratoconus andendothelial dysfunction. The primary disease and the type of endothelium rejectionhave relevance(P=0.000＜0.05). In diffuse type, corneal implant diameter longerthan8mm were21cases, shorter than8mm or equal to8mm were59cases,postoperative time more than6months were27cases, less than6months or equal to6months were53cases. In localized type, corneal implant diameter longer than8mm7cases, shorter than8mm or equal to8mm57cases, postoperative time more than6months43cases, less than6months or equal to6months were21cases. cornealimplant diameter longer than8mm and postoperative time less than6months havesignificant relevance with diffuse type of endothelium rejection(P=0.000＜0.05)Epithelium: edematous area of corneal graft had a disordered arrangement ofepithelial cells. Dendritic cells with large column and highly activation (more andlonger branches) had a distinct infiltration in epithelial basement membrane. The levelof activation was gradually reduced to vanishing after treatment. Quantity of dendriticcells was8.1±3.2/confocal image on average before treatment, and3.8±1.0/confocalimage on average after treatment. There was significant difference between the twogroups (P=0.000＜0.05). Activation of dendritic cells was0.036%±0.047%onaverage before treatment, and0.008%±0.002%on average after treatment. There wassignificant difference between the two groups (P=0.000＜0.05). Quantity of dendriticcells was11.8±4.6/confocal image on average in diffuse type of rejection, and4.9±2.6/confocal image on average in localized type of rejection. There wassignificant difference between the two groups (P=0.000＜0.05). Activation ofdendritic cells was0.044%±0.069%on average in diffuse type of rejection, 0.022%±0.032%on average in edematous area of localized rejection, and0.009%±0.002%on average in transparent area of localized rejection. According tostatistic analysis, there is significant difference among each group (P=0.000＜0.05).Stroma: Stromal cells of edematous area of corneal graft had highly edema anddisordered arrangement. Stromal cells of edematous area can only distinguish partlyof cell nucleus. After formal treatment of anti-rejection, edema of edematous areareversed slowly. Parts of stromal cells were replaced by funicular fibrous tissue, andlead to formation of scar. For that, transparency of corneal graft was affected. Theresult of anterior chamber-optical coherence tomography showed that edema ofcorneal graft had subsided after formal anti-rejection treatment. But because ofstromal scarring, reflection intensity of Stroma had increased. In patients of localizedtype of rejection, there were11whose corrected visual acuity is worse than0.1beforetreatment, and18one year after treatment. There were6whose corrected visual acuityis CF or HM before treatment, and10one year after treatment. In patients of dffusetype of rejection, there were14whose corrected visual acuity is worse than0.1beforetreatment, and27one year after treatment. There were8whose corrected visual acuityis CF or HM before treatment, and16one year after treatment.Endothelium: A large number of immune cells had a distinct infiltration inendothelium layer of edematous area of corneal graft. Parts of the endothelial cells inall sizes lost its normal hexagonal structure. Dark regions scattered in endothelium.Endothelial cells of graft showed segmented or dual nucleus. The density ofendothelial cells was obvious descend. Without formal treatment of anti-rejection, itmay lead to Primary graft failure in several days. In this study, endothelial cell lossrate of edematous area of localized rejection was about44.3±12.8%one week aftertreatment, about57.6±13.1%one month after treatment and about65.3±5.3%threemonth after treatment; endothelial cell loss rate of transparent area of localizedrejection was about17.4±9.3%one week after treatment, about21.7±9.8%one month after treatment and about33.8±5.4%three month after treatment. After three months,the increase of endothelial cell loss rate of localized rejection was became slowlygradually and approached to normal decrease of endothelial cell loss rate. Endothelialcell loss rate of diffuse rejection was about46.2±16.7%one week after treatment,about70.5±6.1%one month after treatment, about78.1±4.8%three month aftertreatment, and about85.9±2.4%six month after treatment. Until six months aftertreatment, the increase of endothelial cell loss rate of localized rejection was becameslowly gradually and approached to normal decrease of endothelial cell loss rate.Conclusion: The primary disease were ocular burns, fungal corneal ulcer andHSK, corneal implant diameter longer than8mm and postoperative time less than6months are easy lead to diffuse type of endothelium rejection. The primary diseasewere leukoma，keratoconus and endothelial dysfunction, corneal implant diametershorter than8mm and postoperative time more than6months are easy lead tolocalized type of endothelium rejection. Endothelial corneal transplantation rejectioncaused damage in all corneal layers and give first place to endothelial cell. Thedamage of diffuse rejection to graft is more serious than localized rejection, requiredtimely and reasonable treatment to reduce damage to the minimum.