JMIR Publications

ABSTRACT

Background:

Anterior chamber-associated immune deviation (ACAID) is an active immunotolerance, which is induced by placing antigen into the anterior eye chamber as long as a major surgical trauma is avoided. For this reason, ACAID may be a major contributor to the favorable immunologic outcomes in Descemet membrane endothelial keratoplasty (DMEK). Rodent models have demonstrated the importance of a functional spleen for the development of an anterior chamber-associated immune deviation.

Objective:

To investigate whether splenectomy leads to increased rejection rates after DMEK in humans.

Methods:

Retrospective evaluation of the course following DMEK at the Eye Center, Medical Center, University of Freiburg for patients with self-reported history of splenectomy compared to patients without this condition.

Results:

We asked 1818 patients after DMEK for a history of splenectomy. 1340 responded and were included into the study. Out of these 1340 Patients 16 patients reported a history of splenectomy (i.e. 26 DMEK with ten patients being transplanted in both eyes and six patients being transplanted in one eye [median age 73.7 years; range 66.7 - 76.1]). The remaining patients served as controls – 2708 DMEK, [median age at surgery 72.0 years; range 64.5 – 77.8]. Five eyes out of the 26 from the splenectomy group required a second transplant due to dislocation (2), failure (2), and rejection (1). Kaplan Meier analysis revealed no relevant difference compared with controls.

Conclusions:

Our results suggest that splenectomy has no effect on the outcome following posterior lamellar corneal transplantation. However, we could include only 16 patients following splenectomy so that it might be possible that we missed to find any effect on graft rejection after DMEK. Following that, ACAID may not be the main reason for the favorable immunological outcomes in DMEK.