Long-Term Outcomes of High-Risk Keratoplasty in Patients Receiving Systemic Immunosuppression

Chow, Sing-Pey; Cook, Stuart D.; Tole, Derek

doi:10.1097/ico.0000000000000615

Cited by 22 publications

(21 citation statements)

References 20 publications

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“… 2 The success of repeat keratoplasty depends on the number of previous failed surgeries, an indication for keratoplasty and the approach used for keratoplasty. 3 - 5 In view of sparing availability of donor material, judicious use of corneal tissue especially in failed keratoplasties is a matter of concern. In a large series of keratoplasty surgeries in the USA, 8.9% were for eyes with failed past keratoplasty surgeries.…”

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confidence: 99%

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Khairallah

2016

SMJ

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Objectives:To report the outcomes of penetrating keratoplasty (PKP) surgeries in eyes with failed PKP.Methods:This was a retrospective, non-comparative, descriptive case series. Thirty eyes of 30 patients with failed PKP comprised our study group, they were reviewed from January 2007 to December 2012 at the King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia. Data were collected on best corrected visual acuity before and after one week, one month, 3 months, 6 months, one year, and 2 years following PKP. Intraoperative and postoperative complications, changes in intraocular pressure (IOP), additional surgical procedure and other ocular comorbidities were also documented. The visual outcomes at 6 months and one year were associated with risk factors.Results:Before intervention, 18 (60%) eyes had vision <20/400. Vision was 20/20 to 20/60 in 10 (30%) eyes at 6 months, 17 (57%) eyes at 12 months, and 22 (73%) eyes at 24 months. The variation in IOP at different follow up periods was not significant (p=0.2). The presence of other ocular comorbidity was not significantly associated with functional visual outcome (p=0.4). Additional surgical procedure after repeat PKP enabled a regain of excellent vision in 9 (47%) eyes at one year. The numbers for past corneal surgeries were significantly associated with the visual outcome at 6 months.Conclusion:Penetrating keratoplasty to manage failed PKP resulted in reducing visual disabilities.

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confidence: 99%

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Khairallah

2016

SMJ

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“…In this study, the rate of rejection episodes in FK506 group was much lower than that in CsA group (P = 0.043). Moreover, the graft survival was signi cantly higher both at 3, 5 years after surgery when comparing with the study conducted by Chow et al 19 Systemic side effects on blood pressure, renal, and liver function were avoided consequently. A small sample size is one limitations of our study, which may in uence the treatment response.…”

Section: Discussionmentioning

confidence: 46%

“…Other risk factors include chemical burn, corneal grafts diameter exceeding 9 mm, perforation or ocular in ammation at the time of surgery, and low recipient age. 13,14,18,19 Immune rejection in high-risk keratoplasty remain a therapeutic challenge to eye doctors.…”

Section: Discussionmentioning

confidence: 99%

Topical administration of tacrolimus and corticosteroids with concentration gradients is effective in preventing immune rejection in high-risk keratoplasty: a 5-year follow-up study

Wang

Zhang

et al. 2020

Preprint

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BACKGROUND: To evaluate the efficacy of topical administration of immunosuppressants and corticosteroids with concentration gradients in the management of patients with high-risk keratoplasty.METHODS: One hundred and six patients treated with topical immunosuppressants (50 eyes in FK506 group and 56 eyes in CsA group) and corticosteroids eye drops with concentration gradients were enrolled in the study. The rate of rejection episodes and irreversible rejection, the graft survival, and related influential factors were evaluated.RESULTS: The mean follow-up period was 48.1±7.9 months (range, 36-60 months). The rate of rejection episodes (P=0.043) and irreversible rejection (P=0.062) was 14.0% and 6.00% in FK506 group, and 37.5% and 7.1% in CsA group, respectively.Kaplan-Meier survival analysis demonstrated a significantly higher graft survival rate of FK506 group (81.6%±5.3%, 71.1%±6.3%), compared with that of CsA group (71.1%±6.3%, 57.5%±7.5%) at 3, 5 years after surgery (P=0.006). The multivariate logistic regression revealed that poor medication compliance with preoperative risk score (≥ 3, P=0.016), and endothelial immune rejection (P=0.033) were risk factors associated with graft survival.CONCLUSIONS: Topical administration of tacrolimus and corticosteroids with concentration gradients is effective in decreasing the incidence of immune rejection in high-risk keratoplasty. Careful instruction of reasonable use of topical tacrolimus to patients is critical to avoid immune rejection induced by stop taking in sudden.

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“…The mean tacrolimus dosage was 2.5 mg/day per patient (range 2–8 mg/day) [53]. Additionally, in another study the oral tacrolimus was started at 0.03 mg/kg per day in 2 divided doses and then adjusted based on clinical efficacy up to 0.08 mg/kg per day [54]. Like CsA, the duration of therapy should be individualized and it is best combined with other agents.…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Update on the Management of High-Risk Penetrating Keratoplasty

Jabbehdari

Rafii

Yazdanpanah

et al. 2017

Curr Ophthalmol Rep

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Purpose of review In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Recent findings Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Summary Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.

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Long-Term Outcomes of High-Risk Keratoplasty in Patients Receiving Systemic Immunosuppression

Abstract: Systemic immunosuppression in patients with high-risk keratoplasty seems to improve graft survival with a median follow-up duration of 5 years and is tolerated by most patients. Despite rejection episodes occurring in 40% of grafts, these were mostly reversible.

Cited by 22 publications

References 20 publications

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Outcome of repeat penetrating keratoplasty in eyes with failed penetrating keratoplasty

Topical administration of tacrolimus and corticosteroids with concentration gradients is effective in preventing immune rejection in high-risk keratoplasty: a 5-year follow-up study

Update on the Management of High-Risk Penetrating Keratoplasty

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