title: [Penetrating keratoplasty in high-risk children: prevention of graft rejection].
abstract: OBJECTIVE
  To evaluate the efficacy of prolonged courses of systemically administered subtherapeutic Metipred and cyclosporine in prevention of graft rejection in high-risk children.
  
  
  METHODS
  The study included 27 children at high risk of graft rejection due to re-keratoplasty (n = 8), limbo-keratoplasty for corneal staphyloma (n = 4), or transplantation into vascularized corneal bed (n = 15). All patients were divided into two groups--the study group (n =11) and the control group (n = 16). In order to evaluate the efficacy of two different prevention schemes, the occurrence of graft rejection, rejection crises, and crisis-associated clouding of the transplant was analyzed.
  
  
  RESULTS
  The occurrence of transplant opacity was two times lower in the Metipred-cyclosporine group than in the conventional prevention group. Kaplan-Meier one-year survival of the transplant was 53% in the study group and 27% in the control group. Two-year survival rate difference appeared even more significant--53% and 18% correspondingly.
  
  
  CONCLUSIONS
  It is clinically shown that subtherapeutic use of Metipred and cyclosporine decreases the occurrence of rejection crises and transplant failure almost by half in high-risk patients as compared with topical corticosteroids; at the same time the side effects of systemic immunosuppression are not substantial. Thus, the suggested prevention scheme allows to perform keratoplasty and expect a clear transplant in children who previously were considered inoperable, i.e. with total vascularized corneal opacity, giant staphylomas, and corneal burns.
authors.forename: A V
authors.initials: AV
authors.lastname: Pleskova
authors.forename: A V
authors.initials: AV
authors.lastname: Khvatova
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D004333:Drug Administration Routes; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006084:Graft Rejection / Q000175:diagnosis / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015948:Keratoplasty, Penetrating / Q000009:adverse effects / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008775:Methylprednisolone