Our Summary

The main problem after a corneal transplant, especially in high-risk eyes with blood vessels already present in the cornea, is the immune system rejecting the graft. This study looked at whether using ultraviolet (UV) light crosslinking could reduce the number of blood and lymphatic vessels in the cornea and therefore increase the chance of a successful transplant.

In tests on mice, the cornea was treated with UVA light and riboflavin, which resulted in a significant reduction in both blood and lymphatic vessels due to the death of cells lining these vessels. There was also a significant decrease in macrophages and CD45+ cells, both types of immune cells that could contribute to graft rejection.

The corneal thickness and the number of keratocytes (a type of corneal cell) were reduced without affecting other parts of the eye, depending on how long the treatment was applied for.

In high-risk eyes that were treated with crosslinking before a corneal transplant, the graft survival rate was significantly better. There was also an increase in a type of immune cell (CD4+CD25+FoxP3+T regulatory cells) that helps prevent graft rejection.

The results suggest that UV light crosslinking could be a new way to improve the success rate of corneal transplants in high-risk eyes by reducing the number of blood and lymphatic vessels in the cornea and decreasing the number of immune cells that could reject the graft.

FAQs

  1. What is the main complication after a corneal transplant?
  2. How can UV light crosslinking improve graft survival after a corneal transplant?
  3. What is the impact of corneal crosslinking on pathologic corneal blood and lymphatic vessels?

Doctor’s Tip

A doctor might advise a patient undergoing a corneal transplant to consider preoperative corneal crosslinking with UV light and riboflavin to regress pathologic corneal blood and lymphatic vessels. This treatment has been shown to improve graft survival and reduce inflammatory cells, potentially leading to better outcomes post-transplantation. It is important to discuss this option with your doctor to determine if it is appropriate for your specific situation.

Suitable For

Patients who are typically recommended for corneal transplant are those with diseases or conditions that affect the cornea, such as keratoconus, corneal scarring, corneal dystrophies, and corneal infections. In particular, patients with pathologically prevascularized high-risk eyes may benefit from corneal transplant with the addition of ultraviolet (UV) light crosslinking to regress pathologic corneal blood and lymphatic vessels. This novel method has been shown to improve graft survival and reduce inflammation in high-risk eyes, making it a promising therapy for patients in need of corneal transplant.

Timeline

Before corneal transplant:

  1. Patient undergoes a thorough eye examination to determine the need for a corneal transplant.
  2. Patient is informed about the risks and benefits of the procedure, and a suitable donor cornea is identified.
  3. Patient may undergo preoperative tests and evaluations to assess overall health and suitability for surgery.
  4. Patient may be treated for any underlying eye conditions or infections to ensure optimal outcomes for the transplant.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, where the damaged or diseased cornea is replaced with a healthy donor cornea.
  2. Patient is closely monitored postoperatively for signs of complications such as infection or rejection.
  3. Patient may be prescribed medications to prevent graft rejection and to aid in healing.
  4. Patient attends follow-up appointments to monitor the progress of the transplant and to make necessary adjustments to medications.
  5. Patient may experience improved vision and overall eye health as the transplanted cornea integrates and heals successfully.

Overall, the patient’s experience before and after a corneal transplant involves thorough evaluation, surgical intervention, postoperative care, and ongoing monitoring to ensure the success of the transplant and optimal visual outcomes.

What to Ask Your Doctor

  1. How does corneal crosslinking with UV light and riboflavin work to regress pathologic corneal blood and lymphatic vessels?
  2. What are the potential risks or side effects of corneal crosslinking for treating corneal neovascularization?
  3. How long does the regression of blood and lymphatic vessels typically take after corneal crosslinking?
  4. How does corneal crosslinking affect other cells in the cornea, such as keratocytes and nonvascular endothelial cells?
  5. Can corneal crosslinking improve long-term graft survival in high-risk eyes undergoing corneal transplant?
  6. How does corneal crosslinking impact the immune response in the cornea, such as the upregulation of CD4+CD25+FoxP3+T regulatory cells?
  7. Are there any specific criteria or considerations for determining if a patient is a good candidate for corneal crosslinking treatment?
  8. What is the typical recovery process after undergoing corneal crosslinking for corneal neovascularization?
  9. How often would a patient need to undergo corneal crosslinking treatments to maintain regression of blood and lymphatic vessels in the cornea?
  10. Are there any alternative treatments or therapies that could be considered for addressing pathologic corneal blood and lymphatic vessels, if corneal crosslinking is not effective or suitable for a patient?

Reference

Authors: Hou Y, Le VNH, Tóth G, Siebelmann S, Horstmann J, Gabriel T, Bock F, Cursiefen C. Journal: Am J Transplant. 2018 Dec;18(12):2873-2884. doi: 10.1111/ajt.14874. Epub 2018 May 26. PMID: 29673063