H. J. M. Völker-Dieben

Different influences on corneal graft survival in 539 transplants

Different influences on corneal survival were studied in 539 grafts. The follow‐up period ranged from 3 months to 4 1/2 years. The degree of vascularization of the host cornea, previous graft failures and the diameter of the graft could be demonstrated to influence the graft survival significantly. A significant influence of sex differences between donors and recipients was found. A female donor results in a better graft survival in female recipients as compared to male recipents. No significant influence on graft survival was found of pregnancies and blood transfusions. Age of the donor, storage methods and time lapse between death and transplantation did not influence the graft survival either.

The effect of prospective HLA-A and -B matching on corneal graft survival

The effect of prospective HLA‐A and ‐B matching on corneal graft survival was studied in 159 Dutch recipients. The follow‐up period ranges from 3 months to 4 1/2 years. In the same period 380 grafts were performed at random. The influence of HLA‐A and ‐B matching on graft survival in all vascularized cases (n = 137) was significant (P = 0.046). If the non‐immuno‐logical failures are excluded the effect of HLA‐A and ‐B matchings becomes more pronounced (P = 0.027). The influence of HLA‐A and ‐B matching on the graft survival of only the first grafts in vascularized corneas was more significant (p = 0.028). Finally a significant influence of HLA‐A and ‐B matching was also found in repeated grafts in vascularized corneas (P = 0.037).

A case of Acanthamoeba keratitis in The Netherlands

A severe kerato-iritis of the right eye of a 36-year-old healthy man constituted a diagnostic and therapeutic problem. More than seven months after the onset of his complaints a cornea transplantation was carried out because a large abscess had developed in the stroma of the cornea and perforation was feared. Amoebae, belonging to the free-living genus Acanthamoeba, were found in the excised corneal disc. Similar infections have been described earlier in the USA, in England and in Germany. The case described here is the first well documented one in the Netherlands. The case history and identification of the amoeba are described. Data from the literature on epidemiology, pathogenicity and treatment are discussed.

The effect of prospective HLA-A and -B matching in 288 penetrating keratoplasties for herpes simplex keratitis

A retrospective review of 288 penetrating keratoplasties (PKP) for herpes simplex keratitis demonstrated a 60.4% survival rate of clear grafts at 3 years. A highly significant difference in corneal graft survival in severely vascularized corneas (57.1 % at 3 years) versus non‐ or slightly vascularized corneas (82.8% at 3 years) was observed (P = 0.009). Prospectively HLA‐A and ‐B matched grafts in vascularized corneas revealed a significantly improved graft survival when compared to unmatched grafts (P = 0.035). Corneal graft survival in eyes grafted ‘à chaud’ was not significantly below the graft survival of vascularized corneas with a clinically non‐active herpetic corneal disease. Recurrence of herpes simplex in the graft was observed in an earlier post‐operative period in HLA‐A and ‐B matched grafts (P = 0.0004).

Advances and disappointments, indications and restrictions regarding HLA-matched corneal grafts in high risk cases.

Abstract54 corneas, 49 high risk cases and 5 low risk cases, were grafted with HLA-matched donor material. The importance of antigen compatibilitiy especially in high risk cases is demonstrated.The percentage of irreversible rejections and reversible rejections in this group is markedly smaller as compared with our own “at random” material and the “at ramdom” material of other authors.The follow-up period is 3–21 months.

Possible relation between HLA and ABO type and prognosis of uveal melanoma

Not only local parameters but also genetic determinants like the HLA genes may play a role in the development and clinical behavior of malignant tumors. In skin melanoma the presence of HLA-B40 is associated with a poor prognosis. We tested the hypothesis that the clinical behavior of uveal melanoma is influenced by the HLA type of the patient. The HLA types of 44 patients with uveal melanoma had been determined before operation with a view to using the cornea of the enucleated eye for an HLA-matched corneal transplantation. We compared the ABO and HLA types of the patients with the development of metastases and with the ten-year patient survival. An association was observed between the presence of HLA-B40 and death due to metastasis of uveal melanoma. We conclude that the HLA type of the patient may influence the clinical behavior not only of skin melanoma but also of uveal melanoma.

The palliative treatment of the dry eye

ConclusionMany factors influence the value of a tear substitute. Not only its therapeutic value, but also the preservative used and the manageability of the container play a very important role.The preference of the patients was for Liquifilm tears and Duratears eyedrops, for the night Vidisic was the most satisfactory preparation. The preservative benzalkonium chloride should be avoided as far as possible because of its cytotoxic action. The clinical picture of hurricane keratitis indicates that too much of this preservative has been applied to the eye.

First experiences with HLA-matched corneal grafts in high risk cases

In highly vascularized corneas the number of graft failures caused by irreversible rejections is higher than in non- or slightly vascularized corneas. The importance of antigen compatibility is demonstrated, especially in these ‘high risk’ cases.Ten highly vascularized corneas were grafted with HLA-matched donor material; only one reversible rejection was seen in this group.Nine non- or slightly vascularized corneas were grafted with donor material chosen at random. Retrospective HLA matching was performed. Three irreversible rejections were seen in this group. The number of HLA incompatibilities was high.

Diagnosis and treatment of complications in the follow-up period after corneal transplantation

Corneal transplantations are usually performed in Eye Clinics. The patients own ophthalmologist usually performs the follow-up examinations because the patients often live a long way from the Clinic.It is very important that these ophthalmologists can diagnose the complications which may occur in the follow-up period and know how to treat them. The complications considered are: glaucoma, marginal infiltrations, epithelial defects, suture infections, wound dehiscence, disturbances of the tear-film and recurrent herpes.Special mention is made of the rejection reaction. This has been recognized for a long time and has received increasing attention in recent years. Both local and general noxae can act as trigger and set off a rejection reaction. Epithelial, endothelial and uveal forms of rejection reaction are recognized.The sooner the immune reaction is recognized and the correct therapy started, the greater the change that graft will become clear again.

CORNEAL GRAFTS FOR ENDOTHELIAL DECOMPENSATION: THE INFLUENCE OF INTRAOCULAR LENSES ON CORNEAL GRAFT SURVIVAL

Re‐examination of the fate of 136 corneal grafts for bullous keratopathy (secondary endothelial decompensation) revealed a decreased, but not significant, graft survival of those grafts compared to the total of 572 grafts in patients with a diagnosis other than bullous keratopathy, as well as a decreased graft survival when compared to the survival of the grafts for Fuchs dystrophy (primary endothelial decompensation). A statistically significant decreased graft survival (P = 0.015) was observed when corneal grafts performed in pseudophakic eyes with secondary endothelial decompensation were compared to those performed in aphakic eyes with secondary endothelial decompensation. An immunological explanation for this difference was not detected. The influence of an intraocular lens on corneal corneal graft survival was analyzed. Indications for removing or retaining the intraocular lens at the time of graft surgery are reported.