Titre du document / Document title

Combined intravenous pulse methylprednisolone and oral cyclosporine A in the treatment of corneal graft rejection: 5-year experience

Auteur(s) / Author(s)

YOUNG A. L. ⁽¹⁾ ; RAO S. K. ^{(1 2)} ; CHENG L. L. ⁽¹⁾ ; WONG A. K. K. ⁽¹⁾ ; LEUNG A. T. S. ⁽¹⁾ ; LAM D. S. C. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, NT, HONG-KONG
⁽²⁾ Sankara Nethralaya Chennai, Tamil Nadu, INDE

Résumé / Abstract

Purpose To report the mid-term results of a treatment strategy using topical steroids, intravenous pulse methyl prednisolone and oral cyclosporine A (CSA) for the treatment of acute corneal graft rejection. Methods Noncomparative, interventional case series. Treatment of corneal graft rejection included 1% prednisolone eye drops, intravenous infusion of 500 mg methyl prednisolone, and oral CSA in two regimens-standard dose was 15 mg/kg/day for 2 days, 7.5 mg/kg/day for 2 days, then adjusted to maintain trough blood levels of 100-200 μg/l; low dose was 2 mg/kg/day with no loading dose. Results Outcome in 34 eyes of 34 patients (21 M;13 F) aged 60 ± 17.7 years (range 9-83 years), who presented after an average duration of 6.6 ± 6.3 days (range 0-30 days) following acute corneal graft rejection, are reported. Twenty-five patients received standard dose CSA while nine patients received the low dose regimen. Mean duration of treatment before reversal of graft rejection was 13.6 ± 12.1 days (range 3-54 days). Treatment was successful in reversing the graft rejection in 32/34 (94%) eyes. Irreversible graft failure occurred in one eye in each group. During a mean follow-up period of 19.2 ± 16.7 months (range 1-55 months), further episodes of graft rejection were seen in 1/32 (3%) eyes. Complications due to treatment included: duodenal ulcer in one patient that responded to medical treatment, and transient elevation in serum creatinine levels in three patients, which returned to normal after decrease in dosage or cessation of oral CSA. Conclusion Our 5-year experience with the use of oral CSA in the treatment of acute corneal graft rejection has shown this treatment approach to be safe and effective in reversing the rejection process. This approach may also protect the graft from subsequent episodes of allograft rejection. A randomised controlled trial to further delineate the role of CSA in reversing acute graft rejection seems warranted.

Revue / Journal Title

Eye   ISSN 0950-222X   CODEN EYEEEC 

Source / Source

2002, vol. 16, n^o3, pp. 304-308 (17 ref.)

Langue / Language

Anglais

Editeur / Publisher

Nature Publishing Group, Basingstoke, ROYAUME-UNI  (1987) (Revue)

Mots-clés anglais / English Keywords

Surgery ; Graft ; Keratopathy ; Eye disease ; Corticosteroid ; Human ; Cornea ; Homograft ; Postoperative ; Complication ; Graft versus host reaction ; Treatment ; Drug combination ; Chemotherapy ; Immunosuppressive agent ; Ciclosporin ; Oral administration ; Intravenous administration ; Methylprednisolone ;

Mots-clés français / French Keywords

Chirurgie ; Greffe ; Kératopathie ; Oeil pathologie ; Corticostéroïde ; Homme ; Cornée ; Homogreffe ; Postopératoire ; Complication ; Maladie greffon hôte ; Traitement ; Association médicamenteuse ; Chimiothérapie ; Immunodépresseur ; Ciclosporine ; Voie orale ; Voie intraveineuse ; Méthylprednisolone ;

Mots-clés espagnols / Spanish Keywords

Cirugía ; Injerto ; Queratopatía ; Ojo patología ; Corticoesteroide ; Hombre ; Córnea ; Homoinjerto ; Postoperatorio ; Complicación ; Enfermedad injerto huesped ; Tratamiento ; Asociación medicamentosa ; Quimioterapia ; Inmunodepresor ; Ciclosporina ; Vía oral ; Vía intravenosa ; Metilprednisolona ;

Localisation / Location

INIST-CNRS, Cote INIST : 21076, 35400010141662.0110