SYSTEMIC CYCLOSPORINE TREATMENT FOR HIGH-RISK CORNEAL TRANSPLANTATION

The success rate for uncomplicated penetrating keratoplasty is very hi gh. However, in high risk patients there is a significantly increased risk for immunologic graft failure and the success rate is relatively poor. Oral cyclosporin A treatment has dramatically decreased the reje ction rate in solid organ transplantation. Its oral use in ophthalmolo gy has so far been relatively limited and topical use restricted by po or penetration of the drug into ocular tissues. The favorable results of oral cyclosporin treatment to prevent corneal graft failure in high -risk patients is demonstrated in this study. High-risk corneal transp lant patients were selected from the general population scheduled to u ndergo corneal transplantation. Twenty-two of 277 patients who were op erated during a four-year period were regarded as highrisk keratoplast y patients, Systemic cyclosporin A treatment (5mg/kg/day) was given pr ophylactically to 14 of these patients who were considered to be at hi gh-risk for keratoplasty rejection (CsA group). In addition the patien ts received a low dose of corticosteroids. Eight similar patients rece iving high dose corticosteroids served as a control group (control gro up). In the CsA group graft survival was 78.6% compared with 37.5% in the control group at 1.5 years. The grafts of patients receiving CsA h ad a significantly better survival rate (p<0.05) than those in control at one and 1.5 years, On the follow-up to four years graft survival i n patients treated with CsA was, however, decreasing to 35.7%. The low graft survival in both high-risk groups is in great contrast to graft survival in all patients operated during the same period (93.1%). Sys temic cyclosporin treatment when received at the time of the operation is effective in reducing failure from irreversible rejection in high- risk keratoplasty, but for maximal effect, a six-month period of treat ment is too short. Subjective side effects were frequent but still acc eptable. Blood tests did not reveal any pathological hepatic or renal laboratory values caused by systemic CsA administration. Careful and f requently follow-ups of the patients are however needed.