Cornea and External Eye Disease: Corneal by Jerry Y. Niederkorn (auth.), Thomas Reinhard, Frank Larkin

By Jerry Y. Niederkorn (auth.), Thomas Reinhard, Frank Larkin (eds.)

The eight ordinary volumes of the "Essentials in Ophthalmology" sequence hide the newest advancements in a single of 8 subspecialties in Ophthalmology. With 4 volumes released in step with yr, each one subspecialty is newly visited each 24 months, with a different concentrate on contemporary advancements. by means of bridging the space among unique study and clinical textbooks, the move of this constructing wisdom into day-by-day perform is significantly enhanced.

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Extra resources for Cornea and External Eye Disease: Corneal Allotransplantation, Allergic Disease and Trachoma

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But transplantation between individuals with identical MHC molecules may also fail in the late phase because at this time the so-called minor-histocompatibility antigens come into play. 3 Chronic Rejection This term is not widely used in corneal transplantation and it is not clearly defined. The pathogenesis of chronic rejection is not clear. Chronic rejection is up to now only characterized by accelerated endothelial cell loss; however, this question is still not answered sufficiently [2, 3]. Chronic rejection cannot be prevented sufficiently with current immunosuppressive drugs (which mainly work through their interference with T cells), so the present strategy is to limit the number of acute rejection episodes.

This shows promise, in that it is likely to suppress some elements of the complex effector phase of graft rejection. 21 Gene Therapy of the Donor Cornea Another possible way to thwart the corneal allograft response is by gene therapy. The cornea is an attractive prospect for gene therapy. Prior to corneal transplantation, the donor cornea is stored for days or even weeks ex vivo, during which time transduction with a vector can be achieved without any urgency. In addition, the anterior segment of the eye is somewhat sequestrated from the general circulation and immune system, which lessens the risk of systemic complications arising from the transgene or the vector.

It is easily accessible and can be examined clinically without difficulty. Two important considerations in gene therapy are the vector and the transgene. 22 Vectors for Gene Therapy of the Cornea An extensive range of viral and nonviral vectors has been used in experimental corneal transplantation studies, but there is no consensus as to the usage of the optimal vector. However, viral vectors are being increasingly preferred by researchers in the field [36]. The most widely used include recombinant adenoviral, lentiviral, and adeno-associated viral vectors.

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