Subconjunctival Injection of Triamcinolone Acetonide in the Management of Corneal Graft Rejection and New Vessels

Athanasiadis, Ioannis; Wit, Deric de; Patel, Amit; Sharma, Anant

doi:10.1177/0091270011400073

Cited by 4 publications

(8 citation statements)

References 48 publications

(61 reference statements)

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“…While several decades have passed since the initial development of corneal transplantation, the mainstay of treatment to increase transplant survival continues to be glucocorticoid therapy. 7–11,22,26 In high risk PK, other immunosuppressive agents have been used but are typically combined with glucocorticoid treatment. 9,11 We hypothesized that fostering a good milieu in the recipient bed by suppressing inflammation and vascularization through steroid pre-treatment would improve corneal engraftment through decreased neovascularization, lymphangiogenesis, and inflammation and result in improved graft survival.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, pre-treatment using longer acting and increased potency glucocorticoids may improve PK outcomes and should be investigated. 7,13,35 …”

Section: Discussionmentioning

confidence: 99%

“…As a result, the mode of delivery should be a consideration when designing treatment regimens aimed at reducing neovascularization and lymphangiogensis, especially in high risk keratoplasty where topical glucocorticoid treatment may not be enough to protect against graft rejection. 1,2,7,21,35,36 …”

Section: Discussionmentioning

confidence: 99%

“…5,6 Corticosteroids are the current standard of care for prevention of graft rejection after PK due to their strong anti-inflammatory effects. 1,7–11 …”

Section: Introductionmentioning

confidence: 99%

“…7,8,12 They also inhibit vascularization and have immunosuppressive action by reducing the number of circulating T lymphocytes. The mechanisms by which glucocorticoids inhibit angiogenesis include direct effects on vascular endothelial cells and indirect effects on other cells, resulting in the inhibition of migration and activation of macrophages, mast cells, and other cell type that release agents contributing to angiogenesis.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Glucocorticoid (Triamcinolone Acetonide) Pretreatment in a Murine Penetrating Keratoplasty and Suture Model

Cho

Uehara

Young

et al. 2012

Cornea

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Purpose To evaluate the effect of glucocorticoid (triamcinolone acetonide injectable suspension) pre-treatment on corneal neovascularization, lymphangiogenesis, and inflammation in a murine penetrating keratoplasty (PK) and corneal suture model. Methods For the PK model, BALB/c mice were used as recipients and C57BL/6 mice were used as donors. A group pre-treated with subconjunctival glucocorticoid and a combination of post-subconjunctival and topical glucocorticoids (Group I) was compared to two groups that did not receive glucocorticoid pre-treatment (one group received a combination of subconjunctival and topical glucocorticoids post-op (Group II), the other group received only topical glucocorticoid treatment post-op (Group III)). All groups were treated with subconjunctival glucocorticoid on the day of surgery. For the corneal suture model BALB/c mice were used. A group receiving only pre-suture glucocorticoid treatment (Group A) and a group receiving only post-suture glucocorticoid treatment (Group C) were compared to a control group that did not receive glucocorticoid therapy (Group B). The degree of neovascularization, lymphangiogenesis, and inflammatory infiltration was compared in each of these models. Results In the PK model, the group receiving glucocorticoid pre-treatment (Group I) showed less neovascularization compared to the post-treatment only groups (Group II: p=0.043, Group III: p=0.020) and less lymphangiogenesis compared to Group III (p=0.005). In the corneal suture model, the glucocorticoid pre-treatment group showed a similar level of neovascularization, lymphangiogenesis, and inflammatory infiltration as the post-treatment only groups (p>0.05). Conclusion Glucocorticoid pretreatment prior to penetrating keratoplasty decreases neovascularization and lymphangiogenesis compared to post-transplant glucocorticoid treatment alone.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, pre-treatment using longer acting and increased potency glucocorticoids may improve PK outcomes and should be investigated. 7,13,35 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…5,6 Corticosteroids are the current standard of care for prevention of graft rejection after PK due to their strong anti-inflammatory effects. 1,7–11 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effect of Glucocorticoid (Triamcinolone Acetonide) Pretreatment in a Murine Penetrating Keratoplasty and Suture Model

Cho

Uehara

Young

et al. 2012

Cornea

View full text Add to dashboard Cite

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Literature review and suggested protocol for prevention and treatment of corneal graft rejection

Magalhaes

Bardan

Zarei-Ghanavati

et al. 2019

Eye

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Effective prophylaxis and treatment of corneal graft rejection are essential to improve outcomes in corneal transplantation. To date, there has been no standardized protocol published that outlines the optimal prophylactic and therapeutic approaches and, furthermore, the published controlled trials on this subject are limited. Likewise, no study has addressed how the level of antigen exposure varies between different types of keratoplasties. The aim of this paper is to provide a simple evidencebased protocol for the prevention and treatment of corneal graft rejection.

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Analysis of Graft Failure After Primary Penetrating Keratoplasty in Children With Peters Anomaly

Sun

Lin

Miao

et al. 2020

Cornea

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Purpose: To investigate the causes of graft failure and risk factors associated with total graft opacity after primary penetrating keratoplasty (PK) in children with Peters anomaly (PA). Methods: In this retrospective study, patients with PA (younger than 5 years) who received primary PK in Beijing Tongren Hospital were reviewed. The follow-up period was a minimum of 6 months. A modified PA classification system was used, and all failed grafts were categorized into partial and total opacity groups. Patient demographics, PA classification, operation details, degree of graft opacity, and causes of graft failure were recorded. Results: Of the 165 eyes, 54 eyes (32.7%) demonstrated graft failure along with various degrees of graft opacity. Approximately half of the grafts applied failed within 6 months postoperatively. The partial and total opacity groups did not demonstrate any significant differences regarding diagnosis distribution. Irreversible immune rejection accounted for 61.1% of all graft failures; furthermore, it had a significantly higher proportion in the partial opacity group than in the total opacity group (71.0% and 47.8%, respectively; P = 0.058). The degree of graft opacity was significantly associated with patient age at surgery (P = 0.002), preoperative corneal vascularization (P = 0.009), and iris defects (P = 0.001). However, administration of intensive topical corticosteroids could reduce the risk of total opacity in the rejected grafts. Conclusions: Irreversible immune rejection is the most common cause of graft failure after primary PK in pediatric patients with PA. The degree of graft opacity is closely related to patient age at surgery, preoperative corneal vascularization, and iris defects.

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Subconjunctival Injection of Triamcinolone Acetonide in the Management of Corneal Graft Rejection and New Vessels

Cited by 4 publications

References 48 publications

Effect of Glucocorticoid (Triamcinolone Acetonide) Pretreatment in a Murine Penetrating Keratoplasty and Suture Model

Effect of Glucocorticoid (Triamcinolone Acetonide) Pretreatment in a Murine Penetrating Keratoplasty and Suture Model

Literature review and suggested protocol for prevention and treatment of corneal graft rejection

Analysis of Graft Failure After Primary Penetrating Keratoplasty in Children With Peters Anomaly

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