This article is more than 5 years old. Information may no longer be current.
Dry eye patients at greatest risk for corneal graft failure
Click Here to Manage Email Alerts
SAO PAULO, Brazil — Patients with severe dry eye are at high risk for rejection of grafts used in ocular surface reconstruction surgeries, according to a presenter here.
José Alvaro P. Gomes, MD, said preoperative preventive measures should be taken to improve management of these patients, including maximizing aqueous tear function with punctual plugs or other therapies.
“Patients with severe dry eye, who have no production of tear film, do very badly,” Dr. Gomes said to attendees at the World Ophthalmology Congress here.
Dr. Gomes said other conditions aside from dry eye can also promote rejection, such as inflammation, immunologic rejection and stem cell exhaustion.
To anticipate complications and improve outcomes, surgeons should learn to pinpoint the exact type of graft failure, as well as when, how and why it occurs, he said.
The earliest stage of failure, known as acute failure, occurs within 1 month of the reconstruction procedure, Dr. Gomes said. Acute failure is often caused by inflammation or infection, he said.
The next stage, classified as early failure, occurs within the first year — typically 2 to 4 months after the transplantation — and is often caused by immunologic rejection. Chronic inflammation is also a problem at this early stage, according to Dr. Gomes.
The final category, late failure, refers to graft failures after 1 year. These are typically known as stem cell exhaustion, referring to the “loss of ability of stem cells to maintain turnover of the corneal epithelial cells,” or a late immunologic rejection, Dr. Gomes said.
Dr. Gomes said research has shown that dry eye and Stevens-Johnson syndrome are the most important diagnostic indicators for graft rejection across the board. Patients with these conditions should be carefully monitored preoperatively and postoperatively to address lid abnormalities and promote normal tear function, he said.
Patients with Stevens-Johnson syndrome or dry eye are considered even more at risk than patients who have sustained ocular injuries, Dr. Gomes noted.