[Preventive systemic cyclosporin A after keratoplasty at increased risk for immune reactions as the only elevated risk factor].
BACKGROUND
In this retrospective study our aim was to evaluate the effectiveness of systemic cyclosporin A (CsA) after keratoplasties with an elevated risk for immune reactions as the only elevated risk factor.


METHODS
Between November 1986 and June 1994, 1121 penetrating keratoplasties, 646 normal-risk and 475 high-risk keratoplasties were performed. In 130 out of the 475 high-risk keratoplasties an elevated risk for immune reactions was the only elevated risk factor. Twenty-six of these 130 high-risk keratoplasties were treated with systemic CsA.


RESULTS
In the high-risk group keratoplasties with an elevated risk for immune reactions as the only elevated risk factor no permanent graft failure occurred with CsA (100% clear grafts). Without CsA the percentage of clear grafts in this high risk group was only 71.7% according to Kaplan Meier 3 years postoperatively in contrast to 86.0% in normal-risk keratoplasties. The differences between these three groups were statistically significant. In the high-risk group keratoplasties with on elevated risk for immune reactions as the only elevated risk factor more immune reactions occurred than without CsA or than in normal-risk keratoplasties. However, these immune reactions were mostly of the benign chronic types.


CONCLUSIONS
Systemic CsA considerably improves graft prognosis after high-risk keratoplasties with an elevated risk for immune reactions as the only elevated risk factor. With CsA application we observed a significant shift from acute to chronic immune reactions, which respond much better to topical steroids.
Reinhard
T
T
Augenklinik, Heinrich-Heine-Universität, Düsseldorf.
Sundmacher
R
R
Godehardt
E
E
Heering
P
P
D016572:Cyclosporine / Q000008:administration & dosage*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D015948:Keratoplasty, Penetrating / Q000276:immunology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016572:Cyclosporine