MAR 2020

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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76 | EYEWORLD | MARCH 2020 C RESEARCH HIGHLIGHT ORNEA by Maxine Lipner Senior Contributing Writer W hile neovascularization is a leading cause for graft failure, it does not appear to be the sole factor, according to Neeru Gupta, MD. A study indicates that lymphatic vessels are also found when there is graft failure in patients. 1 "In every case of graft failure in which there were abnormal blood vessels, we also found lymphatic vessels," Dr. Gupta said. In launching the study, investigators hoped their work might help eliminate the need for future repeat grafts, hypothe- sizing that the lymphatic system might be involved, Dr. Gupta explained. "The eye has traditionally been thought to be devoid of lymphatic vessels," she said. While much time has been spent trying to tackle corneal neovascularization in an attempt to forestall graft failure, graft survival hadn't changed much in 30 years. Testing for lymphatics Unlike traditional blood vessels, lymph is a clear fluid, making it difficult to detect. While it is part of nearly all organs, it is not supposed to be in the cornea. "Our hypothesis was: If we haven't seen any changes, given our current therapeutic approach, maybe there are abnormal lymphatics as part of the process in corneal graft failure," Dr. Gupta said. Systematically, investigators conducted tests on the graft failures, which included not only the usual immunohistochemistry but also testing for messenger RNA associated with lymphatics. With this testing, they were able to identify these lymphatic vessels in all nine of the failed grafts they examined, Dr. Gupta reported. Abnormal blood vessels were easily identified in all. "The lymphatic vessels were distinct and separate," she said. "The fact that we consis- tently found lymphatic vessels in all of the failed grafts in which we detected neovascu- larization suggests that they play some role in corneal transplant failure and that they need attention." Role of lymphatic vessels in failed corneal transplants About the doctor Neeru Gupta, MD Professor and Dorothy Pitts Chair Departments of Ophthalmology & Vision Sciences Laboratory Medicine and Pathobiology St. Michael's Hospital University of Toronto Toronto, Canada Contact Gupta: guptan@smh.ca When performing corneal procedures such as PKP, DALK, DSAEK, and DMEK, lymphatic vessels may play a role in graft failure. Source: Neeru Gupta, MD

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