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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 39 - Corneal transplantation

from Section 7 - Other

Summary

Corneal transplantation, or keratoplasty, is the surgical procedure most commonly used in the management of blinding opacification of the normally transparent cornea. When donor eyes are transported to eye banks, cornea is removed for storage at either 4ºC for up to 10 days in chondroitin sulphate-based medium or 34º C in serum-based medium. Anterior lamellar surgery can be sufficient to restore transparency in those corneas with stromal opacity but healthy endothelium; conversely, posterior lamellar replacement may sluice in those with healthy stroma. Both the anterior chamber together with the peripheral recipient corneal bed and allogeneic donor cornea itself enjoy relative immune privilege. Some features of the immunobiology of corneal rejection differ from allogeneic rejection of other transplanted tissues. The key to successful treatment of corneal graft rejection is early recognition of the rejection episode by the patient and clinician.

Further reading

ChatelMA, LarkinDFP. Sirolimus and mycophenolate as combination prophylaxis in corneal transplant recipients at high rejection risk. Am J Ophthalmol 2010; 150: 179–84.
GeorgeAJT, LarkinDFP. Corneal transplantation – the forgotten graft. Am J Transplant 2004; 4: 678–85.
GoreSM, VailA, BradleyBA, RogersCA, EastyDL, ArmitageWJ. HLA-DR matching in corneal transplantation. Systematic review of published evidence. Corneal Transplant Follow-up Study Collaborators. Transplantation 1995; 60: 1033–9.
NiederkornJY, LarkinDFP. Immune privilege of corneal allografts. Ocul Immunol Inflamm 2010; 18: 162–71.
WilliamsKA, CosterDJ. The immunobiology of corneal transplantation. Transplantation 2007; 84: 806–13.
WilliamsKA, LoweMT, BartlettCM, KellyL, CosterDJ (eds). The Australian Corneal Graft Registry 2007 Report. Adelaide, Australia: Flinders University Press, 2007.