Clinical and immunological results of corneal allograft rejection

Of 111 episodes of graft rejection in 66 patients, 62 responded to therapy with graft clearing (responders); 49 did not (non-responders). Both groups were of similar age, sex, and etiology; both had a similar rate of glaucoma and a similar rate of previous grafting. In responders the graft reaction was shorter in duration (2.2 vs. 5.6 wks., p <0.005), and it was necessary to increase the number of glaucoma medications more often in non-responders compared to responders (41% vs. 19%, p <0.02). The interval from surgery to reaction was similar in responders and non-responders (18.2 vs. 13.3 mos., p >0.1). An epithelial rejection line was present in 11% of responders, but was not present in non-responders (p <0.05). Lymphocytotoxic antibody development correlated with rejection in 16 of 64 episodes. Patients who responded to treatment were more frequently asymptomatic (p <0.05) or were treated earlier following the onset of symptoms compared to non-responders (p <0.0001). These results suggest that, although graft rejection appears to be a more severe form of immunologic reactivity than graft reaction, there is no reproducible laboratory measure of any different basic immunologic mechanism. Clinically, however, reaction is more likely when an epithelial rejection line is present and when the duration of inflammatory activity is short.