Artículos de revistas
Corneal Endothelial Rejection After Penetrating Keratoplasty Treated With Intravenous And Topic Corticosteroid. One Year Follow Up
Registro en:
Revista Brasileira De Oftalmologia. , v. 72, n. 1, p. 42 - 45, 2013.
347280
10.1590/S0034-72802013000100010
2-s2.0-84875869608
Autor
Abe R.Y.
Freire L.M.D.
Castro R.S.
Lira R.P.C.
Arieta C.E.L.
Institución
Resumen
Objective: To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid. Methods: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. Results: A total of 32 eyes from 32 patients (13 male and 19 female) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001). Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047). Conclusion: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment. 72 1 42 45 Patel, S.V., Graft survival after penetrating keratoplasty (2011) Am J Ophthalmol., 151 (3), pp. 397-398 Williams, K.A., Lowe, M.T., Barlett, C.M., Kelly, L., Coster, D.J., (2007) Australian corneal graft registry, , report Adelaide: Flinders University Press 2007 Tan, D.T., Janardhanan, P., Zhou, H., Chan, Y.H., Htoon, H.M., Ang, L.P., Penetrating keratoplasty in Asian eyes: the Singapore Corneal Transplant Study (2008) Ophthalmology., 115 (6), pp. 975-982 Patel, S.V., Diehl, N.N., Hodge, D.O., Bourne, W.M., Donor risk factors for graft failure in a 20-year study of penetrating keratoplasty (2010) Arch Ophthalmol., 128 (4), pp. 418-425 Hill, J.C., Ivey, A., Corticosteroids in corneal graft rejection: double versus single pulse therapy (1994) Cornea., 13 (5), pp. 383-388 Tandon, R., Verma, K., Chawla, B., Sharma, N., Titiyal, J.S., Kalaivani, M., Intravenous dexamethasone vs methylprednisolone pulse therapy in the treatment of acute endothelial graft rejection (2009) Eye (Lond)., 23 (3), pp. 635-639 Costa, D.C., Castro, R.S., Camargo, M.S., Kara-Jose, N., Rejeição de transplantes de córnea: tratamento tópico vs (2008) pulsoterapia - resultados de 10 anos. Arq Bras Oftalmol., 71 (1), pp. 57-61 Krueger, R.R., Ramos-Esteban, J.C., Kanellopoulos, A.J., Staged intrastromal delivery of riboflavin with UVA cross-linking in advanced bullous keratopathy: laboratory investigation and first clinical case (2008) J Refract Surg., 24 (7), pp. S730-S736. , Comment in J Refract Surg. 2009;25(8):687 author reply 687-8 Panda, A., Vanathi, M., Kumar, A., Dash, Y., Priya, S., Corneal graft rejection (2007) Surv Ophthalmol., 52 (4), pp. 375-396. , Review Meyer, P.A., Watson, P.G., Franks, W., Dubord, P., 'Pulsed' immunosuppressive therapy in the treatment of immunologically induced corneal and scleral disease (1987) Eye (Lond)., 1 (PART 4), pp. 487-495