Advancements in Corneal Transplantation: Addressing Rejection Risks, Innovations and Challenges

Abstract

Introduction and Objective: Corneal transplantation is an increasingly common surgical procedure, with lamellar keratoplasty now favored over penetrating keratoplasty due to its advantages in outcomes and precision. Review methods: A literature review utilizing databases like Scopus, Google Scholar, and PubMed, with keywords such as "corneal transplantation rejection" and "high risk of rejection," underscores the need for advancements in understanding and managing graft rejection. Brief knowledge status: Key insights highlight the importance of deeper exploration into the immunological mechanisms of rejection to refine therapeutic strategies. The development of bioengineered materials like acellular porcine corneal stroma (APCS) offers a promising solution to the global donor shortage, though further validation of their clinical utility is needed. Complementary therapies such as amniotic membrane transplantation show promise in mitigating graft failure and treating corneal surface disorders due to their anti-inflammatory and regenerative properties. Moreover, comparative studies suggest that advanced keratoplasty techniques, such as Descemet Membrane Endothelial Keratoplasty (DMEK), may achieve lower rejection rates compared to alternatives like Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Discussion: Future priorities include advancing drug delivery systems, ensuring the feasibility and accessibility of bioengineered materials, and conducting large-scale multicenter trials to validate novel treatments and surgical methods across diverse populations. Summary: Addressing these challenges is particularly crucial for high-risk and pediatric patients, with the ultimate goal of reducing graft failure rates and the necessity for repeat interventions.

Keywords

• corneal graft rejection
• corneal transplant rejection
• corneal transplantation rejection
• pathophysiology of corneal graft rejection
• bioengineered corneal materials