Corticosteroids in corneal graft rejection. Oral versus single pulse therapy.
Forty-eight patients with corneal grafts with severe endothelial rejection were randomly assigned to two treatment groups. One group of 24 patients received prednisolone acetate 1% drops hourly and a single intravenous pulse of 500 mg methylprednisolone. The other group of 24 patients received the same topical therapy plus oral prednisone 60 to 80 mg daily. Nineteen (79.2%) grafts survived in the group that received pulse therapy compared with 15 (62.5%) grafts in the oral group; the difference was not significant (P = 0.17). However, in patients who sought treatment early (less than or equal to 8 days) survival rates were 92.3% and 54.5%, respectively, which indicated a significant advantage for pulse therapy (P less than 0.05). Pulse therapy also appeared beneficial in preventing subsequent rejection episodes. Five (26.3%) of the 19 surviving grafts in the group that received pulse therapy had a further rejection episode compared with 10 (66.7%) of the surviving 15 grafts in the oral group; the difference is significant (P less than 0.025).
Hill
J C
JC
Department of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa.
Maske
R
R
Watson
P
P
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D011897:Random Allocation; D016019:Survival Analysis
D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D008775:Methylprednisolone