Purpose: To describe the clinical features, management, and visual outcome in a case of stromal REJECTION with a rare and unusual presentation after deep anterior lamellar keratoplasty (DALK).Case report: A 25-year-old healthy man with advanced keratoconus underwent DALK using the standard big bubble technique in his right eye. Five months after surgery, the patient involved in red eye, decreased vision, acute epithelial edema, acute and diffuse stromal edema, fine diffuse keratic precipitates (KPs) in the graft location and AC (anterior chamber) inflammation with cells and flair without any vascularization in the graft and recipient bed, and any infiltration or loosening of the sutures. Management with topical and systemic steroids, and topical antibiotic lead to complete resolution of stromal edema, KPs and AC inflammation. Nine months after the first episode, the patient was referred due to the same clinical presentation and similar findings on examination. Recurrence was treated successfully with the same prior medications and clear graft was achieved.Conclusion: Although there is no ENDOTHELIAL immune reaction after DALK for keratoconus, stromal graft REJECTION after DALK can be presented with the same features as ENDOTHELIAL graft REJECTION and should be differentiated from herpes simplex virus (HSV) keratouveitis.

Purpose: To determine whether adding 2% topical cyclosporine (CSA) to local and systemic steroids in treatment of ENDOTHELIAL corneal allograft REJECTION improves the outcome. Methods: A prospective randomized treatment trial was carried out on 40 consecutive corneal graft recipients, presenting with the first episode of ENDOTHELIAL graft REJECTION in two groups. Group one (20 patients) received topical steroid eye drops and oral prednisolone (1 mg/kg). Group two (20 patients) received the same topical and systemic therapy plus 2% cyc1osporine eye drops. The patients were followed up for three months and their clinical outcomes were evaluated by the rates and time for reversal of REJECTION. Results: In group one, 14 (70%) cases had total reversal of graft REJECTION episode which started within a mean period of three days. but in the CSA group, it occurred in 18 (90%) cases which started within a mean period of 1.5 days (P=0.21).Among patients who sought treatment early (< 6 days). survival rates were 85% and 100%, respectively (P=0.2). In high risk patients, the REJECTION reversal rate was 66% in CSA group and 25% in the control group (P=0.5). Conclusion: Addition of 2% CSA eye drop to topical and systemic steroids may improve the rates of graft REJECTION reversal. It may also decrease the interval between initiation of treatment and improvement of clinical signs.

Purpose: To evaluate the microstructural corneal changes during acute ENDOTHELIAL graft REJECTION and following treatment using in vivo confocal microscopy (IVCM). Methods: Patients with a clinical diagnosis of severe acute ENDOTHELIAL graft REJECTION following penetrating keratoplasty were included in this study. IVCM was performed on the 1 st day the patient presented with REJECTION signs and at the time of clinical resolution. Results: Twenty‑, three patients were included in this study. Inflammatory cells appeared as dendritic cells (DCs) and less frequently, as non‑, DCs in basal epithelial and subbasal areas. Activated keratocytes (AKs) (type 1: large cells with visible cytoplasmic processes,type 2: elongated and spindle‑, shaped keratocytes) were visible in acute phase. Following resolution, type 1 AKs considerably reduced, but type 2 cells were more often persisted. Multiple types of keratic precipitates (KPs) were also visible in acute phase which resolved following resolution of REJECTION. Conclusions: Acute graft REJECTION was associated with an increase in the number of DCs, activation of keratocytes, and aggregation of various types of KPs. Inflammatory process subsided in almost all cases, but the IVCM changes did not return to normal early after clinical resolution of REJECTION.

Background: Human cornea expresses functional Fas-ligand capable of killing Fas+ activated lymphocytes. Fas expression is partly regulated by -670 A/G polymorphism in the promoter region of Fas gene.Objective: The aim of the present study is to determine the association between Fas-670A/G polymorphism and survival of corneal transplantation.Methods: In 276 graft recipients who mainly underwent penetrating keratoplasty because of keratoconus, bullous keratopathy and corneal opacity, Fas -670 A/G polymorphism was determined by allele specific oligonucleotide polymerase chain reaction (ASO-PCR) techniques.Results: There was no statistically significant relationship between Fas -670 A/G polymorphism and REJECTION episode (p=0.35). Moreover, the relationship between this polymorphism and REJECTION episode outcome (transplant recovery vs failure). was not statistically significant (p=0.13).Conclusion: The results of the present study show no significant correlation between corneal graft REJECTION, REJECTION recovery and Fas -670A/G gene polymorphism.

The incidence of acute REJECTION of the kidney allograft in the world has been around 15% during the period between 2001 and 2003. It is clinically defined as an elevation in the level of serum creatinine by more than 0.3 mg/dL and is diagnosed by kidney biopsy. On pathologic examination, the interstitium of the allograft is diffusely edematous and infiltrated by CD4 and CD8 lymphocytes. Tubulitis occurs when the lymphocytes and monocytes extend into the walls and lumina of the tubules. Presence of leukocytes determines infection or antibody-mediated REJECTION. Typically C4d staining is negative. Other causes of acute allograft dysfunction included prerenal factors, interstitial nephritis, infection, acute tubular necrosis, toxicity by drugs, and obstruction in the urinary tract.The primary diagnostic assessments include history, especially adherence to immunosuppressive therapy, physical examination, blood and urine laboratory tests, measurement of the serum levels of the drugs, and ultrasonography. Diagnosis of acute cellular REJECTION depends on biopsy, CD20 staining for refractory cases, negative C4d staining, presence of markers of activating lymphocyte, and proteomic study. Treatment of acute cellular REJECTION in kidney transplant recipients include pulse steroid for the first REJECTION episode. It can be repeated for recurrent or resistant REJECTION. Thymoglobulin and OKT3 are used as the second line of treatment if graft function is deteriorating. Changing the protocol from cyclosporine to tacrolimus or adding mycophenolate mofetil or sirolimus might be effective. Prognosis depends on number of REJECTION episodes, the use of potent drugs, time of REJECTION from transplantation, and response to treatment.

Background: Breast cancer is a multifactorial potentially lethal disease that is triggered by genetic factors as well as numerous environmental factors. The present research aimed to examine the expression of Vascular ENDOTHELIAL growth factor messenger RNA (VEGF mRNA), cytokeratin-19 mRNA (CK19 mRNA), and vascular ENDOTHELIAL growth factor (VEGF) protein biomarker in the peripheral blood of patients with breast cancer.Methods: 40 patients with breast cancer were compared to 40 healthy individuals. The real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR) method was used to determine the expressions of the CK19 mRNA and VEGF mRNA biomarkers in the peripheral blood samples of the healthy participants and the patients. The VEGF protein was also compared using the (ELISA) method.Findings: The positive VEGF mRNA biomarker was observed in 30 of the 40 patients with breast cancer; thus the sensitivity of this marker was 75%. In the healthy participants group, 6 of the 40 participants showed a positive VEGF mRNA biomarker expression. The CK19 mRNA marker was positive in 25 of the 40 patients, which indicated a sensitivity of 62.5%. In the healthy participants group, the positive expression of the CK19 mRNA biomarker was observed in 7 of the 40 participants. VEGF was positive in 27 of the 40 patients. In the control group, 5 of the 40 participants showed the positive expression of this biomarker.Conclusion: In sum, based on the results of this research, the assessed breast cancer tumor markers can be used as screening tests for the early diagnosis of patients. To further prove the findings of this study, more extensive studies with larger sample sizes are recommended.

Purpose: To report ENDOTHELIAL corneal graft REJECTION after administration of topical latanoprost eye drops.Case Report: Two eyes of two patients with a history of multiple intraocular procedures prior to penetrating keratoplasty developed ENDOTHELIAL graft REJECTION one month after administration of topical latanoprost. Cystoid macular edema developed simultaneously in one patient.Conclusion: Latanoprost may trigger ENDOTHELIAL graft REJECTION in susceptible eyes.