Vaccine, influenza virus/ vaccine, tetanus Corneal transplant rejection: 5 case 00 reports

Case 1. A corneal transplant W3.S performed on the left eye of a 33-year-old woman with keratoconus No postoperat ive complications occurred . Nine months later the patient received a tetanus toxoid booster Injection Fever, chills and myalgia developed within 4 days followed 2 weeks later by cloudy vIsion In the left eye Classical signs of graft rejection Including Inferior graft oedema, mild anterior chamber reaction and endothelial keratic preCipitates were observed within week of initial vision impairment. Intensive topical corticosteroid and short course oral corticosteroid therapies were administered and the condit ion resolved within 3 weeks .

Two years later the patient received a second penetrating keratoplasty in the same eye because of irregular astigmatism with no complications. Six months later the patient received part 1 of a hepatitis E immunisation ; cloudy vision and general ach iness developed within 24 hours . The patient (a physician), treated herself hourly with topical corticosteroid result ing in recovery 1 week later. Part 2 of the hepatitis B immunisation , administered 1 month resulted in corneal transplant reject ion complications which were again treated by topical corticosteroid administration. After 2 months the graft was still cloudy with scattered keratic precipitates on the inferior endothelium. The corneal oedema and inflammation improved with topical corticosteroid therapy and the graft remained clear .

Case 2: A 84-year-old women received a penetrating keratoplasty in her right eye because o f pseudophakic corneal oedema. Graft rejection occured for 5 weeks after an Influenza immunisation. High-dose topical cort icosteroids resulted in recovery.

Case 3.' Penetrat ing keratoplasty was performed on the right eye of a 73-year-Old woman . Four weeks after an Influenza immunlsallon the pallent developed a diffusely swollen and oedematous graft , revealed by slit­lamp examination , and Visibility had deteriorated to hand mot ions. The patient received intenSive corticosteroid therapy but the graft did not recover.

Case 4: A 69-year-Old woman received a corneal graft with an intraocular lens removed. She had an influenza immunisation 4 months later and developed blurred vision within 8 weeks, though the graft was clear . Topical corticosteroid treatment was administered but within 3 weeks visual blurring developed again , with photophobia and tearing . Topical and oral corticosteroids did not improve the condition . A regraft, which has remained clear, was performed within 1 year of the original graft .

Case 5: A 72-year-old w oman , who underwent a corneal graft Wi th a cataract e xtraction and Intraocular lens Insertion , received an Influenza Immunisation injection 6 mon ths after the operat ion. Within 3 weeks of the injec tion the patient developed blurred vision w ith graft th ickening and kerat iC precipitates on the corneal endothelium. The graft cleared following intensive topical and oral corticosteroid therapy.

'Although the association between graft rejection episodes and immunization was temporal only, immunization Is a control/able situation and patients should be forewarned that the procedure may potentiate a threat to the health of their corneal transplant.'

Stelnemann TL. Koffer BH, Jennings CD Corneal allograft rejection followmg ImmunizallOn American Journal of Oph thalmology 106 575578

Nov 1988