The Efficacy of Low-Dose Systemic Cyclosporine for Graft Failure after Penetrating Keratoplasty in High-Risk Group

Young Joo Cho; Eung Kweon Kim; Hyung Keun Lee

doi:10.3341/jkos.2014.55.1.13

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Cho, Kim, and Lee: The Efficacy of Low-Dose Systemic Cyclosporine for Graft Failure after Penetrating Keratoplasty in High-Risk Group

Original Article

J Korean Ophthalmol Soc 2014;55(1):13-19.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.13

The Efficacy of Low-Dose Systemic Cyclosporine for Graft Failure after Penetrating Keratoplasty in High-Risk Group

Young Joo Cho, MD¹, Eung Kweon Kim, MD^1,², Hyung Keun Lee, MD^1,³

¹Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Institute of Corneal Dystrophy Research, Yonsei University College of Medicine, Seoul, Korea

³Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Hyung Keun Lee, MD Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea, Tel: 82-2-2019-3444, Fax: 82-2-3463-1049, E-mail: shadik@yuhs.ac

Received 8 June 201325 August 2013 Accepted 1 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the effect of low-dose systemic cyclosporine A (CsA) in preventing graft failure after high-risk penetrating keratoplasty (PKP).

Methods

In this retrospective study, 36 eyes of 25 patients who underwent PKP were evaluated. At 24 months post-operatively, the failure rate in the CsA group (n = 19) was compared to the control group (n = 17). For subgroup analysis, the failure rate in the CsA group (n = 9) and control group (n = 9) was compared in patients who underwent a repeat PKP. The patients’ side-effect profile was also collected.

Results

The median follow-up in the CsA group was 32.8 months and 28.9 months in the control group. Graft failure occurred in 31.6% CsA patients and in 68.4% control patients (p = 0.311). In patients with repeat PKP, the failure rate in the CsA group was significantly lower than the control group (22.2% vs. 77.8%, p = 0.018). In one case (5.26%), CsA was discontinued due to gastroinstestinal discomfort.

Conclusions

Low-dose CsA was not beneficial compared to conventional therapy in high-risk PKP patients. However, in the repeat PKP subgroup, the incidence of graft failure was lower with low-dose CsA than with conventional therapy. Although further study is necessary, adding low-dose CsA might be beneficial for repeat PKP patients.

Keywords: Corneal graft failure, Cyclosporin A, Penetrating keratoplasty

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Figure 1.

Comparison of corneal allograft survival between the cyclosporine A and control groups (Kaplan-Meier analysis, Logrank test p = 0.351).

Figure 2.

The graph showing mean blood cyclosporine A con-centration in the low dose systemic cyclosporine A group.

Figure 3.

Change of mean central corneal thickness after penetrating keratoplasty in the cyclosporin A and control groups according to graft survival and failure.

Figure 4.

Comparison of corneal allograft survival between the cyclosporine A and control groups in re-graft cases (Kaplan-Meier analysis, Logrank test p = 0.069).

Table 1.

Baseline patients characteristics and risk factors for graft failure

Characteristic	CsA group (n = 19)	Control group (n = 17)	p-value
Age (years)	62.68 ± 11.40 (31-82)	60.12 ± 16.38 (26-73)	0.981^*
Sex (Male to female ratio)	18:1 (94.7%)	12:5 (70.6%)	0.081^†
Mean follow up period (months)	32.14 ± 5.16	34.55 ± 13.78	0.490^*
Number of previous grafts	1.22 ± 0.67	1.11 ± 0.33	1.000^*
Primary cause			0.582^†
Bullous keratopathy	14	9
Herpes	2	4
Fungal	2	2
Bacterial	1	2

Values are presented as mean ± SD.

CsA = cyclosporin A.

^* Mann-Whitney U test

^† Fisher’s exact test.

Table 2.

Baseline patients characteristics and risk factors for graft failure in two or more penetrating keratoplasties

Characteristic	CsA group (n = 9)	Control group (n = 9)	p-value
Age (years)	60.44 ± 15.44 (31-82)	58.67 ± 19.29 (26-73)	0.965^*
Sex (Male to female ratio)	8:1 (88.9%)	8:1 (88.9%)	1.000^†
Mean follow up period (months)	32.36 ± 5.73	35.09 ± 15.66	0.605^*
Number of previous grafts	1.25 (1-3)	1.11 (1-2)	1.000^*
Primary cause			0.793^†
Bullous keratopathy	6	4
Herpes	2	4
Bacterial	1	1

Values are presented as mean ± SD.

CsA = cyclosporin A.

^* Mann-Whitney U test

^† Fisher’s exact test.

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