Update on the Management of High-Risk Penetrating Keratoplasty

Jabbehdari, Sayena; Rafii, Alireza Baradaran; Yazdanpanah, Ghasem; Hamrah, Pedram; Holland, Edward J.; Djalilian, Ali R.

doi:10.1007/s40135-017-0119-2

Cited by 36 publications

(34 citation statements)

References 104 publications

(115 reference statements)

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“…[8][9][10][11] The main cause of failure was the immunological rejection, that, despite the immune-privilege status of the cornea and the progress in local and systemic immunosuppression therapy, is still a consistent concern. [12][13][14] The survival rates of PK re-grafts were lower than the ones of primary PK, although a statistically significant difference was found only for the 5 years interval (Pearson's chi-square test, p = 0.029). The PK re-grafts group also presented the highest risk of failure, with more than 40% of the failures determined by immunological rejection.…”

Section: Discussionmentioning

confidence: 90%

Corneal graft surgery: A monocentric long-term analysis

Montesel

Barrio

Rubio

et al. 2020

European Journal of Ophthalmology

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Purpose: To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center. Setting: Vissum Instituto Oftalmológico, Alicante, Spain. Methods: A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes. Results: A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques. Conclusion: Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

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Section: Discussionmentioning

confidence: 90%

Corneal graft surgery: A monocentric long-term analysis

Montesel

Barrio

Rubio

et al. 2020

European Journal of Ophthalmology

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“…The 5-year survival rates of corneal grafts are dramatically decreased for high-risk keratoplasty and range between 25% and 65%. [1][2][3][4][5] Although corticosteroids are currently the mainstay of treatment for routine postoperative management, they are insu cient in preventing graft rejection in high-risk patients. 6 For such cases, a variety of systemic immunosuppressants have been administered to prevent or reverse immune rejection.…”

Section: Introductionmentioning

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. 2021

Preprint

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BACKGROUND: To evaluate the efficacy of the 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 the FK506 group and 56 eyes in the CsA group) and corticosteroid eye drops with concentration gradients were enrolled in the study. The rates of rejection episodes, irreversible rejection, 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 rates of rejection episodes (P=0.043) and irreversible rejection (P=0.062) were 14.0% and 6.00% in the FK506 group and 37.5% and 7.1% in the CsA group, respectively.Kaplan-Meier survival analysis demonstrated a significantly higher graft survival rate in the FK506 group (81.6%±5.3%, 71.1%±6.3%) compared with that in the CsA group (71.1%±6.3%, 57.5%±7.5%) at 3 and 5 years after surgery (P=0.006). Multivariate logistic regression revealed that poor medication compliance with a 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 patients on the reasonable use of topical tacrolimus is critical to avoid immune rejection induced by sudden discontinuation of medication.

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“…The 5-year survival rates of corneal grafts decreases dramatically in high-risk keratoplasty, ranging between 25% and 65%. [1][2][3][4][5] Although corticosteroids are currently the mainstay of treatment for routine postoperative management, they are insu cient in preventing graft rejection in high-risk patients. 6 For such cases, a variety of systemic immunosuppressants have been administered to prevent or reverse immune rejection.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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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Update on the Management of High-Risk Penetrating Keratoplasty

Cited by 36 publications

References 104 publications

Corneal graft surgery: A monocentric long-term analysis

Corneal graft surgery: A monocentric long-term analysis

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

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

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