Adverse effects of low-dose systemic cyclosporine therapy in high-risk penetrating keratoplasty

Lee, Jong Joo; Kim, Mee Kum; Wee, Won Ryang

doi:10.1007/s00417-015-3008-0

Cited by 13 publications

(5 citation statements)

References 37 publications

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“…A total of 88 subjects receiving cyclosporine treatment, in comparison with 185 subjects without cyclosporine therapy, were evaluated for the adverse effects of immunosuppressive treatment. The results showed that herpes keratitis occurred in 31.8% of the patients receiving cyclosporine, compared to 16.8% in the control group (p = 0.023), indicating the possible promoting role of cyclosporine in HSV infection [26]. Contradicting results were obtained in several recent studies, which showed the beneficial effect of topical cyclosporine 2% eye drops in the treatment of herpetic stromal keratitis.…”

Section: Herpes Simplex Virusmentioning

confidence: 91%

“…A study was conducted to compare the frequency of herpes keratitis after penetrating keratoplasty in two groups of patients [26]. A total of 88 subjects receiving cyclosporine treatment, in comparison with 185 subjects without cyclosporine therapy, were evaluated for the adverse effects of immunosuppressive treatment.…”

Section: Herpes Simplex Virusmentioning

confidence: 99%

“…Hepatitis C [15][16][17] Influenza virus infection [28] Rotavirus infection [29,30] Human Immunodeficiency Virus infection [26,33,34] Coronavirus infection [39][40][41][42][43] Hepatitis B [10][11][12][13][14] Hepatitis D [12,20] Herpes simplex infection [26,27] Herpes Zoster Virus infection [35,36] Hepatitis E [21] Cytomegalovirus infection [19,20,22] Human Papilloma Virus infection [29,30] Human Herpesvirus-8 (Kaposi Sarcoma virus) infection [42,43] The possible beneficial effect of cyclosporine on the course of COVID-19 seems very probable. Thus, it is not justified to suggest that patients with autoimmune diseases should discontinue cyclosporine therapy solely because of the COVID-19 pandemic.…”

Section: Possible Negative Effect Of Cyclosporine On Disease Coursementioning

confidence: 99%

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The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections

Głowacka

Rudnicka

Warszawik-Hendzel

et al. 2020

Biology

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This review updates current knowledge regarding the risk of viral infections, including COVID-19, in patients treated with cyclosporine. We also shortly refer to bacterial infections and parasitic infestations in patients treated with cyclosporin. Cyclosporine is an immunosuppressive drug, which is widely used in medicine, including in the treatment of autoimmune skin diseases in dermatology, rheumatology, ophthalmology and nephrology, and in organ transplantation. A usual concern associated with immunosuppressive treatment is the potential risk of infections. Interestingly, several data indicate a relatively low risk of infections, especially viral infections, in patients receiving cyclosporine. It was shown that cyclosporine exerts an inhibitory effect on the replication of some viruses, or may have a potentially beneficial effect on the disease course in infections. These include hepatitis C, influenza virus, rotavirus, human immunodeficiency virus and coronavirus infections. Available data indicate that cyclosporine may have a beneficial effect on COVID-19, which is caused by the coronavirus SARS-COV2.

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Section: Herpes Simplex Virusmentioning

confidence: 91%

Section: Herpes Simplex Virusmentioning

confidence: 99%

Section: Possible Negative Effect Of Cyclosporine On Disease Coursementioning

confidence: 99%

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The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections

Głowacka

Rudnicka

Warszawik-Hendzel

et al. 2020

Biology

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“…The results of systemic CsA in the prevention of high-risk corneal transplantation rejection were inconsistent [ 17 ]. The most common adverse events of CsA therapy in high-risk corneal transplants were herpes keratitis and hypertension [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Management and Treatment Outcomes of High-Risk Corneal Transplantations

Urbańska¹,

Woźniak²,

Więsyk³

et al. 2022

JCM

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Corneal transplantation is the most effective treatment for corneal blindness. Standard planned keratoplasties have a high success rate. Conditions such as active inflammation at the time of surgery, the presence of ocular surface disease, previous graft disease, or neovascularization make them more susceptible to rejection. These are so-called high-risk corneal transplantations. In our study, we selected 52 patients with a higher risk of graft rejection. A total of 78 procedures were performed. The main indications for the first keratoplasty were infections (59.6%) and traumas (21.2%). Visual acuity (VA) significantly improved from 2.05 logMAR on the day of keratoplasty to 1.66 logMAR in the latest examination (p = 0.003). An analysis of the graft survival showed a 1-year survival of 54% and a 5-year survival of 19.8% of grafts. The mean observation time without complications after the first, second, and third surgery was 23, 13, and 14 months, respectively. The best results were noted among patients with infectious indications for keratoplasty (p = 0.001). Among them, those with bacterial infection had the best visual outcomes (p = 0.047).

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“…Cornea is the only transplant specialty that does not use the principles of immunosuppression, which are not needed for routine keratoplasty but are beneficial in high-risk keratoplasty (ie, previous graft rejection or stromal neovascularization) in addition to OSSTx. 62–95 The authors, as a group, have used SI on over 1000 patients and have seen minimal severe adverse events (rare cardiovascular disease and 1 secondary malignancy) and no deaths. We have published on our use of these medications and the protocol to adopt the principles of SI from organ transplantation experts, notably nephrology (the Cincinnati Protocol).…”

Section: Obstacles In Adoption Of Osstx With Simentioning

confidence: 99%

Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency?

Holland

Cheung

Djalilian

et al. 2023

Cornea

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Purpose: To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption. Methods: A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial. Results: Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist. Conclusion: There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.

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Adverse effects of low-dose systemic cyclosporine therapy in high-risk penetrating keratoplasty

Abstract: The results of this study suggest that low-dose oral CsA therapy may induce various adverse effects, the most common of which are herpes keratitis and hypertension.

Cited by 13 publications

References 37 publications

The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections

The Antiviral Properties of Cyclosporine. Focus on Coronavirus, Hepatitis C Virus, Influenza Virus, and Human Immunodeficiency Virus Infections

Management and Treatment Outcomes of High-Risk Corneal Transplantations

Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency?

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