Systemic cyclosporine in high-risk keratoplasty: long-term results.
Systemic cyclosporine (CSA) was given to 43 high-risk keratoplasty patients (vascularisation in three or four quadrants and > 16 stromal vessels): 14 received CSA for 12 months (long CSA group) and 29 for a 4-6 month period (short CSA group). A group of 37 similar high-risk keratoplasty patients received no CSA (no CSA group). In the no CSA group 27 (73%) grafts had rejection episodes compared with 21 (48.8%) in the combined CSA group (p = 0.025). Rejection was reversed in only 23.3% of the no CSA group, compared with 50% and 87.5% in the short (p = 0.06) and long (p = 0.002) CSA groups respectively. Compared with the no CSA group, overall graft survival was better in both the short (p = 0.019) and long (p = 0.0056) CSA groups. This improvement resulted from both a reduction in the incidence, and an increase in the reversal rate, of rejection episodes. The improvement continued after stopping CSA, suggesting that some immunological privilege had been re-established. Acuities of 20/40 or better were achieved by 44.8% and 50% of eyes in the short and long CSA groups respectively, compared with 13.5% of eyes in the no CSA group.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016039:Corneal Transplantation; D016572:Cyclosporine / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008134:Long-Term Care; D008875:Middle Aged; D011446:Prospective Studies; D014792:Visual Acuity
D007166:Immunosuppressive Agents; D016572:Cyclosporine