Intravenous dexamethasone vs methylprednisolone pulse therapy in the treatment of acute endothelial graft rejection.
OBJECTIVE
To study the outcome of therapy for acute endothelial graft rejection with an intravenous (i.v.) pulse of dexamethasone vs methylprednisolone, in addition to topical corticosteroids.


METHODS
Records of 98 eyes of 99 patients treated for endothelial graft rejection with a single i.v. pulse of dexamethasone or methylprednisolone in addition to topical steroids, between January 1999 and June 2004, were retrospectively reviewed. Baseline characteristics such as surgery-rejection interval, time taken to consult after onset of symptoms, history of failed grafts, extent of stromal vascularization, best-corrected visual acuity (BCVA) and corneal thickness at the time of presentation were noted. Main outcome measures following treatment for rejection included improvement in BCVA, change in corneal thickness, and reversal of graft rejection.


RESULTS
Fifty-one patients were treated with i.v. methylprednisolone and 47 with i.v. dexamethasone, in addition to topical steroids. Both groups were found to be comparable with respect to baseline parameters, that is, time taken to present, history of failed grafts, extent of stromal vascularization, BCVA, and graft thickness. Graft rejection could be successfully reversed in 72.3% cases in the dexamethasone group and 49% in the methylprednisolone group (P=0.018). A significant improvement in visual acuity was recorded following treatment in both groups, with a better outcome in the dexamethasone group (P=0.012). Post-treatment pachymetry values were lower than pretreatment values in both groups, with significantly lower final pachymetry in the dexamethasone group (P=0.017). No adverse effects were observed.


CONCLUSIONS
I.v. pulse therapy with dexamethasone may be used as an effective alternative to methylprednisolone in reversing acute endothelial graft rejection.
Tandon
R
R
Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. radhika_tan@yahoo.com
Verma
K
K
Chawla
B
B
Sharma
N
N
Titiyal
J S
JS
Kalaivani
M
M
Vajpayee
R B
RB
D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003315:Cornea / Q000473:pathology; D016039:Corneal Transplantation; D003907:Dexamethasone / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006084:Graft Rejection / Q000188:drug therapy* / Q000469:parasitology / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects
D005938:Glucocorticoids; D003907:Dexamethasone; D008775:Methylprednisolone