The document discusses corneal allograft rejection. It begins by describing the structure of the cornea including its immune privilege properties. The cornea has an absence of blood vessels and lymphatics and expresses Fas ligand which helps prevent rejection. Keratoplasty procedures like penetrating keratoplasty are used to transplant donor corneal tissue. Risk factors for rejection include inflammation and vascularization. Rejection types include epithelial, subepithelial, and endothelial rejection. The immune mechanism involves antigen presentation by donor and recipient antigen presenting cells to recipient T cells, leading to direct and indirect rejection pathways over time. Treatment focuses on immunosuppression to prevent the immune response.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
ORGAN FAILURE AND TRANSPLANTATION MEDICINEdrpriyanka8
TRANSPLANTATION
GRAFT
ORGAN TRANSPLANT
HEART, KIDNEY, LIVER, LUNG FAILURE
HISTORY
TYPES OF TRANSPLANT
ALLOGRAFT
XENOGRAFT
ISOGRAFT
ALLOGRAFT
TYPES OF DONOR
GRAFT ACCEPTANCE
GRAFT REJECTION
ROLE OF T CELL
GENETICS
RECOGINITION OF ALLOANTIGENS
EFFECT OF HLA MATCHING
ROLE OF BLOOD GROUPS
MECHANISM OF ACCEPTANCE
MECHANISM OF REJECTION
STAGES OF REJECTION
GRAFT VS HOST REACTION
MANIFESTATIONS
PREVENTION OF REJECTION
IMMUNOSUPPRESION
Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment. The majority of victims are young and exposure occurs at home, work place and in association with criminal assaults. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Emergency management if appropriate may be single most important factor in determining visual outcome.
WHAT IS OTITIS EXTERNA & IT’S TYPE
TREATMENT OF DIFFERENT TYPES OF OE
DIAGNOSTIC EVALUATION AND HISTORY TAKING
COMPLICATIONS AND DIFFERENTIAL DIAGNOSIS
MANAGEMENT & PREVENTION
PRESCRIPTION OF PROBABLE DIAGNOSIS
Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and eardrum.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
5. ENDOTHELIAL FUNCTION
Endothelial cells
nonreplicative in humans
pump water from stroma to anterior
chamber
If loss of sig. number decompensation of
pump function stromal swelling loss
of transparency & vision
Hongmei Fu.Transplantation Reviews 2008;105-115
6. IMMUNE PRIVILEGE OF CORNEA
Cornea is immune privileged tissue
Absence of lymphatic & blood vessels in
corneal graft bed
Expression of Fas ligand on corneal cells
Low-level expression of MHC class I and II
molecules on corneal cells
Paucity of indigenous professional antigen-
presenting mФ, Langerhans cells
Hongmei Fu.Transplantation Reviews 2008;105-115
7. IMMUNE PRIVILEGE OF CORNEA
Cornea is immune privileged tissue(cont.)
Phenomenon of anterior chamber-associated
immune deviation (ACAID)
down regulation of systemic DTH from
alloantigens in anterior chamber
Presence of immunomodulatory cytokines in
aqueous humor in anterior chamber such as
Α-melanocyte-stimulating hormone
Transforming growth factor
Hongmei Fu.Transplantation Reviews 2008;105-115
8. IMMUNE PRIVILEGE OF CORNEA
rejection rate at the final
observation (8 weeks) in the
FasL- group (89%) was
significantly higher than in
the FasL+ control group
(47%)
9. IMMUNE PRIVILEGE OF CORNEA
Jerry Y. Niederkorn. Ocular Immunology & Inflammation 2010; 18(3); 162–171
10. IMMUNE PRIVILEGE OF CORNEA
Anterior chamber–associated immune
deviation (ACAID)
form of eye-derived tolerance which TH1 & TH2-
mediated immunity is suppressed
characterized by a selective deficiency in delayed
type hypersensitivity (DTH) and Ig isotypes that
fix complement
Koh-Hei Sonoda . J. Exp. Med 1999 ; 190 (9): 1215–1225
12. IMMUNE PRIVILEGE OF CORNEA
Anterior chamber–associated immune
deviation (ACAID)
CD4+ Treg known as “afferent Treg” suppress
initial activation & differentiation of naïve T cell
into TH1 effector cells : secondary lymphoid
organs
CD8+ Treg known as “efferent Treg” inhibit
expression of TH1-mediated immunity, such as
DTH : periphery(eye)
J.Wayne Streilein. NATURE REVIEWS IMMUNOLOGY 2003 :879-880
13. IMMUNE PRIVILEGE OF CORNEA
Wilbanks, G. A 1992
Taylor, A. W. 1992
Taylor, A. W. 1994
Taylor, A. W. 1998
Sheibani, N. 2000
Apte, R. S. 1998
Kennedy, M. C. 1995
Sohn, J. H., 2000
Sugita, S. et al. 2000
J.Wayne Streilein. NATURE REVIEWS IMMUNOLOGY 2003 :879-880
15. IMMUNE PRIVILEGE OF CORNEA
Conclusion
Immune privilege consists of 3 majors
mechanism
1) Anatomical, molecular barriers in eye
2) Eye-derived immunological tolerance
known as “ACAID”
3) Immune suppressive intraocular
microenvironment
16. OUTLINES
STRUCTURE OF CORNEA, ENDOTHELIAL FUNCTION
AND IMMUNE PRIVILEGE
CORNEAL ALLOGRAFT REJECTION
Keratoplasty
Risk factor & Types of rejection
clinical features
Immune mechanism of corneal allograft rejection
PREVENTION & TREATMENT OF CORNEAL
ALLOGRAFT REJECTION
17. CORNEAL ALLOGRAFT REJECTION
Keratoplasty
plastic surgery of the cornea
lamellar keratoplasty
a partial thickness graft of the cornea
only epithelium and superficial stroma is
removed
replaced by donor tissue from penetrating or
full-thickness grafting
18. CORNEAL ALLOGRAFT REJECTION
Keratoplasty (cont.)
optic keratoplasty
transplantation of corneal material to replace scar
tissue that interferes with vision
penetrating keratoplasty
a full thickness of the cornea is removed and
replaced with donor tissue, 1st performed in 1906
tectonic keratoplasty
transplantation of corneal material to replace
tissue that has been lost
19. CORNEAL ALLOGRAFT REJECTION
Common indications to perform keratoplasty
therapeutic(e.g. keratoconus, corneal ulcer)
cosmetic (e.g. removing an unsightly opacity)
20. CORNEAL ALLOGRAFT REJECTION
RISK FACTORS
Tham and Abbott. International Ophthalmology Clinic 2002;42(1):105-113
21. CORNEAL ALLOGRAFT REJECTION
TYPES OF REJECTION
A. Epithelial rejection
host epithelium grows inward from remaining host
cornea & limbus to cover the graft
B. Subepithelial rejection
subepithelial infiltrates with leukocytes
Both types are
steroid responsive
generally self-limited
tends not to cause visual disturbance
asymptomatic or only of minimal irritation
22. CORNEAL ALLOGRAFT REJECTION
TYPES OF REJECTION
C. Endothelial rejection
Classic rejection presents with endothelial
rejection line (Khodadoust line : consist of
mononuclear white cells) usually begins at
vasculaized portion of peripheral graft-host
junction & progress across endothelial surface
Damaged endothelium is unable to dehydrate
corneal graft cloudy & edematous stroma
23. CORNEAL ALLOGRAFT REJECTION
CLINICAL FEATURES
Tham and Abbott. International Ophthalmology Clinic 2002;42(1):105-113
26. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
Inflamed cornea contribute to erosion of
privilege
With inflammation
Bone marrow-derived cells are recruited into cornea through
limbal circulation
Those cells capable of processing & presenting antigens
when inflammation is resolved persist for months or years
The greater number of bone marrow-derived cells in host
cornea at time of surgery the higher the rejection rate
Chronic inflammation induces generation of blood vessels &
lymphatics in normally avascular cornea
DJ Coster et al. Eye 2009; 23: 1894-1897
27. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
With inflammation (cont.)
Induces vessels to leak, facilitating ingress of
cells & proteins into cornea
Macrophage produce VEGF-C which induce
growth of lymphatics
Pro-inflammatory cytokines gain access to
cornea & anterior chamber encourage
rejection
DJ Coster et al. Eye 2009; 23: 1894-1897
28. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
Antigen processing can occur at cornea, ocular
environs and draining lymph nodes
Recipient T cells recognition of donor MHC
alloantigens plays central role in rejection by 2
mechanisms
Direct pathway : donor APCs are recognized directly by recipient T
cells (important role in acute graft rejection)
Indirect pathway : recipient APCs process antigen then present it
to recipient T cells (associated with chronic graft rejection)
Direct pathway weakens with time (donor APCs migrate out of
graft) but indirect be permanently active cause of recipient
APCs traffic through the graft
DJ Coster et al. Eye 2009; 23: 1894-1897
Hongmei Fu et al. Transplantation Review 2008; 22: 105-115
29. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
conclusion
Jerry Y. Niederkorn. Current Eye Research 2007; 32: 1005-1016
32. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
T.H. Flynn et al. American Journal of Transplantation 2008; 8: 1537-1543
33. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
T.H. Flynn et al. American Journal of Transplantation 2008; 8: 1537-1543
34. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
peripheral During
Blood rejection
rejection Aq. Humor
peripheral
control
T.H. Flynn et al. American Journal of Transplantation 2008; 8: 1537-1543
35. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
cytometric bead array of inflammatory cytokines & chemokines
T.H. Flynn et al. American Journal of Transplantation 2008; 8: 1537-1543
36. CORNEAL ALLOGRAFT REJECTION
IMMUNE MECHANISM
Conclusion
Few absolute principles
T cell-dependent
Heavily depent upon CD4+ T cells
Dependent upon intact repertoire of resident
APC (macrophage, monocyte)
T.H. Flynn et al. American Journal of Transplantation 2008; 8: 1537-1543
37. OUTLINES
STRUCTURE OF CORNEA, ENDOTHELIAL FUNCTION
AND IMMUNE PRIVILEGE
CORNEAL ALLOGRAFT REJECTION
Keratoplasty
Risk factor & clinical features
Immune mechanism of corneal allograft rejection
PREVENTION & TREATMENT OF CORNEAL
ALLOGRAFT REJECTION
38. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Incidence of corneal graft rejection from 2.3%-68% in
different studies, at least one episode of rejection may occur
30% of graft
Polack(1973) report an incidence of homograft rejection in
good prognosis cases to be 9–12%, whereas in retrospective
study over 12 years Smiddy et al.(1986) state incidence to be
approximately 16%
Overall
12% of low-risk
40% of high-risk
Rejection most common occurs 4-18 Mo following
transplantation (may seen any time after surgery)
53.3% occurr during the 1st year after transplantation
Alireza Baradaran-Rafii et al. Iranian Journal of Ophthalmic Research 2007; 2(1) : 7-14
Sangwan VS et al. Clin Experiment Ophthalmol 2005; 33(6):623-627
39. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Dj Coster and KA Williams. Eye 2003; 17: 996-1002
40. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Low risk
Topical corticosteroids (prednisolone) still universally
used for routine postoperative management during 1st 6
Mo, after 6 Mo generally prescribed less frequently
25% switch to loteprednol, 20% to fluorometholone in
phakic patients (due to their lesser effect on intraocular
pressure )
In Pseudophakic/Aphakic eyes topical corticosteroids
(prednisolone) used as phakic patients but % usage of
this preparation increased greater than the latter
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
41. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
42. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Intermediate-high risk
Topical corticosteroids (prednisolone) still universally
used for routine postoperative management during 1st
6 Mo, and remained high % usage after that
Topical cyclosporine is used about 48%, evidences are
controversial
Sytemic steroids (oral)
In USA used lesser than before , compared in 1989 and
2004
In UK used greater than in USA
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
43. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
44. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
45. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Price MO and Price FW Jr. Ophthalmology 2006; 113(10): 1785-1790
46. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
regimen B had
sig. more
rejection than
regimen A
regimen
C did not
reduce
incidence
of rejection
Price MO and Price FW Jr. Ophthalmology 2006; 113(10): 1785-1790
47. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Alexander Poon FRANZCO et al. Clinical and Experimental Ophthalmology 2008; 36: 415-421
48. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
Alexander Poon FRANZCO et al. Clinical and Experimental Ophthalmology 2008; 36: 415-421
49. PREVENTION OF CORNEAL ALLOGRAFT REJECTION
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
50. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
Hill and colleagues (1991) demonstrated in
prospective study that
IV methylprednisolone 500 mg single dose was more
effective and better tolerated than daily oral
prednisolone 60-80 mg when combined with topical
steroids in graft rejection
Survival rate of graft 92% versus 55% when pts. were
treated within 8 days of onset of symptoms
(no difference in outcome in who presented later
than day 8)
Vivien M.-B. Tham and Richard L. Abbott. International Ophthalmology Clinics 2002; 42(1): 105-113
52. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
J. Bradley Randleman and R. Doyle Stulting. Cornea 2006; 25(3): 286-290
53. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
T Hudde et al. British Journal of Ophthalmology 1999; 83: 1348-1352
54. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
T Hudde et al. British Journal of Ophthalmology 1999; 83: 1348-1352
55. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
In case of mild rejection
Topical prednisolone acetate 1% hourly and
dexamethasone ointment at night was sufficient to
reverse the rejection
In severe case of rejection
Topical prednisolone acetate 1% hourly, one dose of
pulsed IV methylprednisolone 500 mg and oral
prednisolone 1 mg/kg/day for 5 days were recommended
The collaborative corneal transplantation studies
Arch Ophthalmol 1992;110:1392–1403
Vivien M.-B. Tham and Richard L. Abbott. International Ophthalmology Clinics 2002; 42(1): 105-113
56. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
In severe case of rejection(cont.)
In 1989 Hill found that graft survival improved if
systemic cyclosporine was used in addition to
systemic & topical steroids (89%) compared to
use of topical steroids alone (10%)
Maximum effect was obtained if cyclosporine
was used for 12 Mo (93% survival rate)
compared with 6 Mo (69% survival rate)
Vivien M.-B. Tham and Richard L. Abbott. International Ophthalmology Clinics 2002; 42(1): 105-113
57. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
In severe case of rejection(cont.)
In1999 Alexander Reis et al. reported a
prospectively randomised clinical trial about
mycophenolate mofetil versus cyclosporn A
Due to wide range of S/E of cyclosporin A
(diabetogenicity, arterial hypertension, HLP,
nephrotoxicity) which could be found about
10% and to need lab. monitoring of drug levels
between 120-150 ng/ml very costly
Alexander Reis et al. British Journal of Ophthalmology 1999; 83: 1268-1271
58. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
MMF is just as effective
as CSA in preventing
acute rejection
following high risk
corneal transplantation
Alexander Reis et al. British Journal of Ophthalmology 1999; 83: 1268-1271
59. TREATMENT OF CORNEAL ALLOGRAFT REJECTION
Recent study from Joseph A and colleagues found that
systemic tacrolimus daily dose 2.5 mg is safe and
effective in reducing rejection & prolonging graft
survival in pts. With high-risk keratoplasty compared
with pts who did not use.
A Joseph et al. British Journal of Ophthalmology 2007; 91: 51-55