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Effect of Allergic Conjunctival Inflammation on the Allogeneic Response to Donor Cornea

¹From the Department of Ocular Immunology, Institute of Ophthalmology, London, United Kingdom; and the ²Moorfields Eye Hospital, London, United Kingdom.

PURPOSE. Immunologic rejection is the most common cause of corneal allograft rejection. Ipsilateral ocular inflammation has been identified as a predictor of future corneal graft failure. This study investigates the effect of perioperative allergic conjunctivitis on corneal allograft survival.

METHODS. C57BL6 donor corneas were transplanted into naive A/J mice, A/J mice sensitized to short ragweed (SRW) pollen by intraperitoneal injection and then challenged with topical SRW to induce allergic conjunctivitis (Sens⁺Chall⁺), and A/J mice sensitized to SRW and challenged with topical PBS (Sens⁺Chall^–). Syngeneic grafts were also performed in eyes with allergic conjunctivitis. Graft survival and infiltrating cell phenotype in rejected grafts were compared between groups.

RESULTS. Mice with allergic conjunctivitis (Sens⁺Chall⁺) rejected corneal allografts significantly more quickly than naive mice. Syngeneic grafts in allergic eyes survived indefinitely. The rate of rejection in Sens⁺Chall^– mice was similar to that in naive mice. There were no significant differences, between groups, in the numbers of infiltrating CD4⁺ cells, CD8⁺ cells, and macrophages at the time of graft rejection. Eosinophils were seldom observed in rejected grafts in naive and Sens⁺Chall^– mice but were observed consistently in Sens⁺Chall⁺ eyes. Eosinophils were also found consistently in the ciliary body of Sens⁺Chall⁺ eyes at the time of graft rejection.

CONCLUSIONS. Active allergic conjunctivitis at the time of transplantation accelerates corneal allograft rejection. Local conjunctival inflammation is an important factor in accelerating rejection.