Case-control study of subconjunctival triamcinolone acetonide injection vs intravenous methylprednisolone pulse in the treatment of endothelial corneal allograft rejection.
OBJECTIVE
To assess the safety and effectiveness of treating corneal endothelial rejection with a subconjunctival injection of 20 mg triamcinolone acetonide in combination with topical application of 1% prednisolone acetate, as compared to treatment with an intravenous pulse of 500 mg methylprednisolone in combination with topical application of 1% prednisolone acetate.


METHODS
A case-controlled study including a literature review was performed. Patients who presented with an initial episode of corneal endothelial rejection were treated with subconjunctival injection of 20 mg triamcinolone in combination with topically applied 1% prednisolone and were retrospectively matched for age and diagnosis to patients who received a single intravenous injection of 500 mg methylprednisolone in combination with topical 1% prednisolone. Patients were analysed regarding reversion of the rejection episode, intraocular pressure, and visual acuity after 1 year.


RESULTS
Overall, the triamcinolone group had a better outcome regarding reversion of corneal transplant rejection (P=0.025), with 15 of 16 patients in the triamcinolone group having clear grafts, compared to only 10 of 16 patients in the methylprednisolone group. Intraocular pressure (IOP) was increased in both groups at day 30 (P=0.002), although there was no statistically significant difference in IOP between the groups (P=0.433). Visual acuity improved in both groups after 1 year (P=0.049), although slightly more improvement was observed in the triamcinolone group (P=0.002).


CONCLUSIONS
The results observed in this case-controlled study suggest that the use of subconjunctival triamcinolone acetonide may benefit patients with corneal transplant rejection.
Costa
D C
DC
Department of Ophthalmology and Otolaryngology, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil. daciocosta@hotmail.com
de Castro
R S
RS
Kara-Jose
N
N
D016022:Case-Control Studies; D016039:Corneal Transplantation; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D056965:Injections, Intraocular; D007275:Injections, Intravenous; D007429:Intraocular Pressure / Q000187:drug effects; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use; D014792:Visual Acuity / Q000187:drug effects
D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone; D014222:Triamcinolone Acetonide; D008775:Methylprednisolone