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A. Joseph, V.A. Shanmuganathan, D. Raj, R. Powell, H.S. Dua; Tacrolimus in the management of high–risk corneal grafts . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2908.
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Purpose: To assess the efficacy of the immunosuppressive agent tacrolimus in the management of high–risk corneal grafts Methods:46 patients who had at least 2 quadrants of stromal vascularisation and/or at least one previous failed graft were treated with tacrolimus at doses of 2 to 8 mg/day (mean 2.7mg/day). Graft rejection and survival were the main outcome measures. All patients were given a risk score as follows: each previous graft (1), each quadrant of stromal vascularization (1), each quadrant of peripheral anterior synechia (1), preoperative glaucoma (1), herpes simplex keratitis (2), chemical burn (4). The median risk score was 5 and median follow up was 24 months. Tacrolimus was stopped in most patients at 18 months post–keratoplasty if rejection free, or 1 year after the last rejection episode. Results: 4 patients discontinued tacrolimus due to side–effects, a further 10 patients had graft failure not related to rejection and 4 had irreversible graft rejection whilst on tacrolimus. 4 patients had reversible graft rejection whilst on tacrolimus. The corneal grafts remain clear in 28 patients, of whom 15 have successfully stopped treatment (median follow up 25 months). 4 patients had reversible graft rejection after stopping tacrolimus. Conclusions: Of the 46 patients on tacrolimus, 8 patients (17%) experienced rejection episodes, of whom 4 had rejection related graft failure. Compared to published literature, use of tacrolimus was associated with a reduced incidence of rejection and rejection related failure in high–risk corneal grafts.
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