Chapter 19. Difficulties in the Use of Tissue Typing for Corneal Grafting
- Ruth Porter,
- Julie Knight
Published Online: 30 MAY 2008
Copyright © 1973 Ciba Foundation
Ciba Foundation Symposium 15 - Corneal Graft Failure
How to Cite
Watson, P. G. and Joysey, V. C. (2008) Difficulties in the Use of Tissue Typing for Corneal Grafting, in Ciba Foundation Symposium 15 - Corneal Graft Failure (eds R. Porter and J. Knight), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470719985.ch19
- Published Online: 30 MAY 2008
- Published Print: 1 JAN 1973
Print ISBN: 9789021940168
Online ISBN: 9780470719985
- corneal grafting;
- immunosuppressive treatment;
- avascular corneas;
- liquid nitrogen;
Attempts have been made for the past five years to tissue type corneal donors prospectively and to select the most compatible material for grafting. The problems encountered are:
- (1)Failure to obtain blood for tissue typing.
- (2)Failure to contact the potential recipient or persuade him to have the graft.
- (3)When a patient has been admitted as an emergency requiring urgent transplantation, no donor has been available. As these recipients were grafted with corneas from an eye bank, no donor blood was obtainable and therefore tissue typing was impossible.
- (4)No case of identity of HL-A antigens was achieved between donor and recipient, and therefore no good match is available for comparison with the poorly matched material.
All patients except one required some immunosuppressive treatment, suggesting that mild rejection phenomena occur even in apparently well-tolerated grafts. There was a significant association between preoperative vascularization of the cornea and rejection changes in the subsequent graft. It would seem therefore that tissue matching is probably unnecessary in patients with avascular corneas.
Twenty-seven out of 33 patients with previously vascularized corneas showed rejection changes. In half of these the changes were reversible, resulting in a clear graft; the rest became opaque. Within the group with preoperative vascularization there was no significant difference between the HL-A match grades of those grafts that cleared and those that became opaque. This is not surprising because the final series of tissue-typed material is very small and no perfectly matched material was available for comparison. In order to obtain evidence on whether HL-A matching of donor and recipient can improve the prognosis of corneal grafts in preoperatively vascularized corneas we suggest that the assistance of the National Organ Matching and Distribution Services at Bristol be sought to obtain some perfectly matched grafts so that a valid comparison can be made.