角膜移植术后免疫排斥反应的防治

The treatment of allograft rejection after corneal transplantation.

目的 为控制角膜移植术后发生排斥反应,探讨防治排斥反应的有效途径。方法 根据不同角膜病变排斥反应发生的规律给予不同期的药物联合治疗,降低和控制排斥反应。结果 129眼中47眼(36.43％)发生免疫排斥反应,其中高危角膜病变40眼,非高危角膜病变7眼。有角膜新生血管者占89.36％。排斥反应发生时间为术后3周～3年。经药物联合治疗,角膜排斥反应得到明显的抑制,有效率达63.83％。结论 免疫排斥反应的发生是多因素参与的复杂过程,尤其高危角膜病变,术后出现排斥反应的机率明显增加,发生的时间相对较早,时间跨度较长。因此应根据不同的角膜病变及手术情况,尽早应用免疫抑制剂可明显降低排斥反应的发生率。

Objective To develop an effective approach to control and treat allograft rejection after corneal transplantation. Methods According to the different preexisting diseases of the recipient corneas, immunosuppre-ssive drugs were administered simply or in combination. Results 47 out of 129 eyes experienced allograft rejection. The rejection rate in high risk patients was 85.11 % (40/47) , in low risk eyes was 14. 8 % (7/47) . In the vascularized corneas,it was 89.36%(42/47) .The incipient of rejection varied from 3 weeks to 3 years after corneal transplantation. The crucial episodes were 3-6 months after corneal transplantation. In this period, the total rejection rate was 46.81% .After immunosuppressive drugs were administered, 63. 83 % percent allograft rejection was effectively blocked. Conclusion Many factors contribute to the complicated allograft rejection of corneal transplantation. In vascularized, inflamed, regraft corneas,the allograft rejection occur more often,more early,and more severe and last for a longer time. So in such cases, immunosuppressive drugs should be prophylactically administered in combination and may help reverse an ongoing graft-rejection episode.