FAQ
Question: What are the rejection rates for a stromal transplant vs pkp vs endothelial? We already know that graft survival rates are better in Keratoconus patients vs non Keratoconus patients.
Answer: Fascinating question! After doing stromal transplants for 20 years, here are the key points…
THE OCULAR SURFACE IS AN INFLAMMATORY POWERHOUSE. WE ALMOST ALWAYS UNDERTREAT THIS INFLAMMATION, which is a form of ocular disrespect.
Most rejections in full transplant BEGIN AS STROMAL REJECTION.
Primary endothelial rejection is much less common than primary stromal rejection in full transplants.
Primary stromal rejection can lead to endothelial rejection in full transplants.
PERSONAL UNPROVEN OPINION: Based on what I have seen over the years, I believe there is a separate type of immunological response within the eye compared to external. I have no idea how to investigate this.
Stromal transplants are different: I consider rejection more an inflammation simply because it disappears with drops.
Peak timing for stromal inflammation is around 9 months.
I think at least 10% of stromal transplants will show inflammation.
Stromal inflammation can be nummular or frank stromal swelling.
Vascularisation can occur and if caught early, is reversible. If late, lipid deposits and fibrous pannus remain.
The major cause of inflammation is failure to use, or failure to prescribe long term steroids.
Other factors include sutures, viral conjunctivitis, the cough or a cold…yes, upper respiratory tract infections cross react with the ocular surface!!!!!
After a period of 18 months, the risk of stromal inflammation settles. Stromal rejection rarely leads to transplant failure.
Question: Does “adjusting “ a stromal transplant like the below, add to the numbers on the corneal graft registry for failure?
Answer: Failure is a label, a reductionist approach to fit a complex issue into the limitations of the human mind.
Just what is failure?
In life, failure is the road to success; ln biology, failure is a revealing of the limitations of our thinking and actions.
The tissue is beautifully clear because it hasn’t failed…the wound has simply been stretched.
Wound revision is part of any surgery.
We can help
If you suffer from a corneal issue and think we can help, then you can request an appointment online or call the clinic on 1300 393 322. We have 2 Sydney locations for consultation, Westmead and the city on Macquarie Street opposite the Eye Hospital.