Evaluation of triggers for corneal graft rejection.

BACKGROUND AND OBJECTIVE: To evaluate potential triggering factors contributing to corneal graft rejection. PATIENTS AND METHODS: A prospective, case control study was conducted over a five month period. All patients presenting with new onset corneal graft rejection were enrolled into the study group. Two patients with clear grafts who presented shortly after each enrolled study group patient served as controls. Groups were matched for age, preoperative diagnosis, and number of previous keratoplasties. Participating patients and examining ophthalmologists filled out questionnaires regarding infectious, environmental and immunologic exposures. RESULTS: 66 patients were enrolled into the study, of which 22 had new rejection episodes. The most prevalent diagnoses were keratoconus (36.6%) and herpes simplex keratitis (22.7%). Anterior chamber reaction (77.3%) and keratic precipitates (68.2%) were the most common signs of graft rejection. A history of prior rejection episodes was significantly more frequent in the study group population (p < 0.001). Factors such as sun exposure, stress, smoking and travel were more prevalent in the rejection group but not statistically significant. The history of recent vaccinations and allergic reactions were equally prevalent in both groups. CONCLUSIONS: The new onset of corneal graft rejection was highly associated with a prior history of graft rejection episodes (p < 0.001). Other analyzed factors were not significant triggering factors for rejection in this small series.

Ocular manifestations of systemic infections.

Systemic infections occasionally present with ocular involvement. Prompt diagnosis and management, aided by an internist, may lead to resolution of the infection without severe ocular sequelae. Recent literature discussing atypical ophthalmic manifestations, treatment options, or transmission risks of the following diseases is reviewed: infection with hepatitis viruses, toxoplasmosis, tuberculosis, bacteremia, and endogenous mycotic endophthalmitis.

The contralateral corneal endothelium in the iridocorneal endothelial syndrome.

OBJECTIVE: To evaluate the corneal endothelial morphometric measures of the contralateral, clinically uninvolved eye of patients with the iridocorneal endothelial (ICE) syndrome. DESIGN: A retrospective review of the specular microscopic photographs of the contralateral corneal endothelium of all patients with ICE syndrome seen at Mayo Clinic, Rochester, Minn. SETTING: Ophthalmology department, Mayo Clinic. PARTICIPANTS: Twenty-eight patients with unilateral ICE syndrome who had bilateral endothelial photographs (ICE group) and 28 normal, age-matched control subjects (control group). MAIN OUTCOME MEASURES: Percentage of hexagonal cells, coefficient of variation of cell area, and endothelial cell density. METHODS: For each patient and control, 100 endothelial cells were digitized from projected endothelial photomicrographs of the central corneas in the uninvolved eyes. RESULTS: A statistically significant decrease was noted in the mean percentage of hexagonal cells (ICE, 62%; control, 69%; P = .002), and an increase was noted in the mean coefficient of variation of cell area (ICE, 0.28; control, 0.25; P = .02) in the patients with ICE syndrome compared with normal, age-matched controls. The mean endothelial cell density did not differ significantly between the 2 groups (ICE, 2588; control, 2759; P = .10). CONCLUSION: Our data suggest that the clinically uninvolved, contralateral eyes in patients with ICE syndrome have subclinical endothelial abnormalities as evidenced by a relatively low percentage of hexagonal cells and a relatively high coefficient of variation of cell area.