AIM: To investigate the infiltration and activation of lymphocyte in iris-ciliary body and anterior chamber after allogenic penetrating keratoplasty (PK), for further revealing the role of iris-ciliary body in corneal allograft immune rejection. METHODS: In the mice models of PK, BALB/C mice received orthotopic isografts (n =35) or C57BL/6 donor allografts (n =25). Grafts were examined daily for 3 weeks by slit-lamp microscopy and scored for opacity. The infiltration of CD4+ T lymphocyte in iris-ciliary body and anterior chamber was examined by immunohistology and the mRNA of CD80 and CD86 in both cornea graft and iris-ciliary body by RT-PCR was analyzed in allograft recipient at days 3, 6, 10 and the day when graft rejection occurred. Isograft recipients were examined as control at the corresponding time points. Transmission electron microscope was used to study the ultrastructure, especially cell infiltration, of iris-cilary body and corneal graft at day 3, 7 and the day when rejection occurred after allogenic PK. RESULTS: Rejection was observed in all the allograft recipients followed more than 10 days, at a median time of 15 days (range 12-18 days), but not in any of isografts. CD4+ T cells were first detected at day 6 after transplantation in limbus and Ciliary body, and then in the stroma of recipient, iris, anterior chamber and corneal allograft with an increased number until graft rejection occurred. CD80 and CD86 mRNA were detected under RT-PCR examination in both graft and iris-ciliary body of allograft recipient, but not in any of isograft recipient. Three days after operation, lymphocytes and monocytes macrophages were visible in iris blood vessels and the anterior chamber, and vascular endothelial cell proliferation and activation were significant under transmission electron microscopy examination. At day 7, corneal endothelial cells became thinner. Lymphocytes and mononuclear macrophages were found with great number in the anterior chamber and adhered to the corneal endothelium. Blood vessels in iri
Fu-Hua WangMin ChenTing LiuXin-Jie ZangHua-Qing GongWei-Yun Shi
AIM:To identify the current indications and the trend shifts for penetrating keratoplasty(PKP) in Shandong.METHODS:The medical charts of all patients who underwent PKP at Shandong Eye Institute from June 1,2005 to May 31,2010 were analysed retrospectively.RESULTS:A total of 875 patients(875 eyes) received PKP in this 5-year period,accounting for 61.6% of all corneal transplantation surgeries.The leading indications for PKP were infectious keratitis(37.1%),HSK(19.1%),keratoconus(11.2%),bullous keratopathy(8.5%),regrafting(6.7%) and corneal scarring(4.8%).The percentage of PKP for keratoconus declined year by year,whereas the percentage of bullous keratopathy had a mild annual increase.Fungal infections accounted for 65.2% of the infectious keratitis cases,remaining the leading cause of corneal infection.In addition,54.1% of bullous keratopathy cases were associated with cataract surgery.The leading initial diagnoses associated with regrafting were infectious keratitis(38.9%),HSK(18.6%) and corneal burn(16.9%).The major causes of regrafting included graft endothelial dysfunction(39.0%),graft ulcer(28.8%) and primary disease recurrence(15.3%).CONCLUSION:Infectious keratitis remained the leading indication for PKP in Shandong,and fungal infections were still the major cause of corneal infections.There was an increasing trend in the percentage of PKP cases indicated for bullous keratopathy but a decline in the same for keratoconus.Even with a decline in the overall proportion among all corneal transplantation surgeries,PKP is still the major corneal transplant choice in Shandong.
