Artikel
Impact of short-term versus long-term topical steroid treatment on the incidence of immunological graft rejection following penetrating normal-risk keratoplasty
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Autoren
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N.X. Nguyen
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
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C. Cursiefen
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
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A. Langenbucher
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
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B. Seitz
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
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F.E. Kruse
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen
| Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
To assess the impact of the duration of topical steroid treatment on the incidence of immunological graft rejection following penetrating normal risk keratoplasty (PK).
Methods
The study included 406 eyes from the prospective Erlangen Normal-Risk-Keratoplasty Study with a mean follow up of 42±18 (median 40) months. Indications for PK were keratoconus in 48%, Fuchs' dystrophy in 30%, secondary bullous keratopathy in 11%, nonvascularized corneal scars in 7% and stromal dystrophies in 4%. Exclusion criteria included vascularization of the recipient cornea of more than three clock hours, limbal stem cell deficiency, servere tear film insufficiency, systemic immunosuppression and regrafts. The postoperative treatment started initially with prednisolone acetate 1% eye drops five times daily and was tapered slowly over the first 6 months. Patients were then randomised in two treatment groups: Short-term group: stop topical steroid treatment; Long-term group: continue topical treatment with prednisolone acetate 1% eye drops once a day until 12 months postoperatively. All patients underwent a standardised protocol of follow-up examinations in our Cornea Outpatients Service at 6 weeks, 3, 6 months, then every 3 months until 2 years, after that once a year.
Results
Out of 406 patients, 202 patients were randomised in the short-term group and 204 were in the long-term group. Indications for PK, mean follow-up and all donor parameters did not differ significantly between two groups. During follow-up 29 eyes (7.1%) developed an episode of endothelial graft rejection. Episodes of graft rejection were significantly higher in the short-term group (19 of 202; 9.1%) than in the long-term group (10 of 204: 4.9%) (p=0.001). The time interval between graft rejection and PK was 14±7 months in the short-term group and it was 13±6 months in the long-term group. Episodes of endothelial graft rejection clustered in both groups between 11 and 25 months postoperatively (10 of 19: 53% vs. 5 of 9: 56%).
Conclusions
Our study gives exact and controlled data on incidence of episodes of endothelial graft rejection following normal-risk PK. Long-term low-dose topical steroid treatment seems to have a protective effect on the incidence of immunological graft rejection. Our results serve to optimise postoperative treatment following penetrating normal-risk keratoplasty.
Support
BMBF (IZKF Erlangen, project B 13) and Neurocenter, Erlangen.
