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. 2001 Dec;85(12):1464–1469. doi: 10.1136/bjo.85.12.1464

Systemic cyclosporin A in high risk penetrating keratoplasties: a case-control study

A Poon 1, J Forbes 1, J Dart 1, S Subramaniam 1, C Bunce 1, P Madison 1, L Ficker 1, S Tuft 1, D Gartry 1, R Buckley 1
PMCID: PMC1723819  PMID: 11734522

Abstract

AIM—To examine the efficacy of systemic cyclosporin A (CSA) in preventing rejection and graft failure in high risk keratoplasty (PK).
METHODS—A retrospective case-control study with 49 patients in both the CSA group and the control group. The patients receiving CSA were at high risk of graft rejection and failure. Controls were identified from surgical audit books and had high risk characteristics.
RESULTS—There was no statistical difference in preoperative risk factors and the use of postoperative topical steroids between the two groups. The median follow up in the CSA group was 22 months and 27 months in the control group. One or more rejection episodes occurred in 18 out of 49 (36.7%) cases in the CSA group and 26 out of 49 (53.1%) in the control group. Graft failure from all causes occurred in 16 (32.7%) CSA patients and 18 (36.7%) control patients. Four (8.2%) of the CSA group compared to eight (16.3%) in the control group failed because of rejection. 22 (44.9%) out of 49 patients in the CSA group had side effects. In five (10.2%) patients, CSA was stopped because of the side effects; eight patients had elevated serum urea and creatinine and four developed hypertension. Minor side effects reported include gum hyperplasia, increased sweating, backache, nausea, feeling unwell, oral candidiasis, cramps, and paraesthesia of the extremities.
CONCLUSION—These results suggest that the benefit of CSA over conventional therapy in preventing rejection episodes and subsequent graft failure is only moderate and did not reach statistically significant levels in this study. Considering the high frequency of side effects and the cost of CSA, a randomised control trial may be necessary to determine the true value of CSA in high risk penetrating keratoplasty.



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Figure 1  .

Figure 1  

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Kaplan-Meier survival estimates for rejection. Difference between the CSA and control groups was not significant when compared by log rank and Wilcoxon (Breslow) tests. The number of study patients at risk at various points after time zero are shown below the horizontal axis.

Figure 2  .

Figure 2  

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Kaplan-Meier survival estimates for failure from rejection. Difference between the CSA and control groups was not significant when compared by log rank and Wilcoxon (Breslow) tests. The number of study patients at risk at various points after time zero are shown below the horizontal axis.

Figure 3  .

Figure 3  

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Kaplan-Meier survival estimates for failure (all causes). Difference between the CSA and control group was not significant when compared by log rank and Wilcoxon (Breslow) tests. The number of study patients at risk at various points after time zero are shown below the horizontal axis.

Figure 4  .

Figure 4  

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Visual acuity (corrected or with pinhole) of control patients, preoperative versus postoperative acuity. VA units: 0 = no perception of light, 1 = perception of light, 2 = hand movement, 3 = counting fingers, 4 = 6/60, 5 = 6/36, 6 = 6/24, 7 = 6/18, 8 = 6/12, 9 = 6/9, 10 = 6/6. Solid circle represents the "no change" line where the postoperative acuity equals preoperative acuity; bar represents the postoperative VA plotted against the preoperative VA. Those above the line of "no change" represent an improvement of VA.

Figure 5  .

Figure 5  

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Visual acuity (corrected or with pinhole) for CSA patients, preoperative versus postoperative VA. VA units: 0 = no perception of light, 1 = perception of light, 2 = hand movement, 3 = counting fingers, 4 = 6/60, 5 = 6/36, 6 = 6/24, 7 = 6/18, 8 = 6/12, 9 = 6/9, 10 = 6/6. Solid circle represents the "no change" line where the postoperative acuity equals preoperative acuity; bar represents the postoperative VA plotted against the preoperative VA. Those above the line of "no change" represent an improvement of VA.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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