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Telmo Xabier Lerchundi Plaza, Ainhoa Ibarrola Vidaurre, Beatriz Jiménez Gómez, Maria Sanchez Lopez, Sandra De Fernando Aisa, Ricardo Martinez Fernandez, Juan A Duran, Nerea Martínez Alday, Jaime Etxebarria; Systemic cyclosporine treatment in primary pediatric keratoplasty. Evaluation of results.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3134.
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© ARVO (1962-2015); The Authors (2016-present)
To study the characteristics, indications and outcomes of pediatric keratoplasties comparing the influence of the systemic treatment with oral cyclosporine A. All the keratoplasties, treatment and follow up were done in one Hospital.
Retrospective review of primary keratoplasties in children under 14 years old, between 1997 and 2011. Graft survival and best corrected visual acuity was evaluated in children with oral cyclosporine A treatment. The criteria for surgical indication were best corrected visual acuity less than 0.3, preferential vision less than 0.1 cycles per minute, opacity in visual axis more than 3mm, deprivation signs or difficulty to fundus visualization. The treatment with oral cyclosporine A was started as the keratoplasty was done. The initial dose was between 5 y 7 mg/kg/day , later it was regulated.
A total of 17 primary keratoplasties were performed in 15 patients between 1997 and 2011. The median age was 18.6 months (minimum 18 days and maximum 13.4 years). Children were treated with oral cyclosporine A for 1 year after surgery. The median follow up is 40 months. The indications were congenital opacities in 8 eyes, acquired non traumatic opacities in 6 eyes and 3 eyes had posttraumatic scars. The graft was transparent (11/15) or with low opacity (2/15) in 86.7% (13/15) of cases at 12 months, in 64.2% of cases at 2 years and 61.6% at 3 years. At 12 months follow up only two grafts were rejected (13.3%). The median T0 at 2 weeks follow up was 140 ng/ml (DT: 46.7) and at 12 months 98 ng/ml (DT :37.3). The renal toxicity was controlled with the blood pressure measure and eGF (Schwartz) checking. The median eGFR value at 2 weeks was 133 (DT:47.3) and 158 (DT:38.4) at one year. The median duration of the oral treatment was 12.3 months. The side effects observed were: 7 childs with mild hirsutism, 4 with low gingival hyperplasia and 1 with insomnia.
Although the heterogeneity of the surgical indications makes difficult to compare the results of different series, oral cyclosporine A seems to be a good treatment to improve the outcomes of pediatric keratoplasty. Althought some side effects appear in our serie, it is a safe immunosuppressive agent and could improve the survival of the grafts. This is maybe the first series of cases treated with this procedure and has obtained good results.
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