Corneal endothelial rejection after penetrating keratoplasty treated with intravenous and topic corticosteroid: one year follow up

Revista Brasileira de Oftalmologia

Ricardo Yuji Abe¹  Lívia Maria Dias Freire¹  Rosane Silvestre Castro¹  Rodrigo Pessoa Cavalcanti Lira¹  Carlos Eduardo Leite Arieta¹ 

[1],Universidade Estadual de Campinas Hospital das Clínicas Department of OphthalmoloyCampinas SP ,Brazil

关键词: Keratoplasty;    penetrating;    Graft rejection;    Adrenal cortex hormones;    Risk factors;    Methylprednisolone;    Methylprednisolone;    Treatment outcome;    Ceratoplastia penetrante;    Rejeição de enxerto;    Corticosteróides;    Fatores de risco;    Metilprednisolona;    Metilprednisolona;    Resultado de tratamento;   

DOI  :  10.1590/S0034-72802013000100010

来源: SciELO

【 摘 要 】

OBJECTIVE: To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid. METHODS: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. RESULTS: A total of 32 eyes from 32 patients (13 male and 19 female) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001). Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047). CONCLUSION: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment.

【 授权许可】

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