Effect of Azathioprine (Imuran) on Corneal Graft Reaction

Azathioprine and Cytarabine Applied Topically Prolong Corneal Graft Survival in Rabbits

“…This nucleic acid biosynthesis inhibition suppresses immunologically com petent cell proliferation after the antigen stimulation and destroys sensitized lympho cytes. Applied both intramuscularly and subconjunctivally in the experiments on rabbits, azathioprine prolongs corneal graft survival time; histologic examination of rabbit cor neal grafts rejected during and after azathio prine therapy indicated cellular infiltration with markedly smaller lymphocyte count and plasma cells in comparison with the con trol group [10,11]. This azathioprine effect was less prominently pronounced when ap plied topically as an ointment [11], Azathio prine, when used systematically in combina tion with prednisolone (locally + systemati cally), provided corneal graft transparency preservation in 2 patients with keratitis of unknown etiology and 4 keratoplasties pre viously performed with subsequent graft ha ziness due to the rejection reaction [12].…”

“…Since the antigenic stimulation begins im mediately after the corneal grafting, it is nec essary to initiate the immunosuppressive treatment without delay. A less prominent effect of the topically applied azathioprine as an ointment [11] can probably be explained by the fact that the treatment has been started 3 days after the corneal grafting.…”

Bilateral Macular Hemorrhage Caused by Azathioprine-Induced Aplastic Anemia in a Corneal Graft Recipient

“…[2][3][4] The frequency and severity of adverse effects with AZA treatment depend on the dose and duration of therapy and underlying disease (renal, hepatic) that can potentate toxicity. Although reports in the ophthalmic literature suggest that AZA is well tolerated, vigilant hematological monitoring is critical because bone marrow suppression with leukopenia and thrombocytopenia can occur.…”

“…1 Immunosuppressive drugs are often used to enhance graft survival in patients who have a high risk of corneal graft failure. [2][3][4] The systemic side effects of such medications are well known, and patients should be closely monitored for the occurrence of these events. Ocular complications after the use of these medications for eye diseases are less commonly reported.…”

Corticosteroids and Anti-Complement Therapy in Retinal Diseases

“…Its use in ophthalmic disease was first in the treatment of corneal graft rejection (Polack 1967) and later for noninfectious ocular inflammatory conditions (Pasadhika et al 2009) such as active chronic iridocyclitis (Mathews et al 1969), Behçet's disease (Yazici et al 1990), and retinal vasculitis (Greenwood et al 1998). …”