Purchase this article with an account.
Q Ge, HA Fuchs, M Wang; A New Triple-drug Regimen for Systemic Immunosuppression for Corneal Limbal Stem Cell Allograft . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2211.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe and evaluate the efficacy of a new triple-drug regimen for systemic immunosuppression for corneal limbal stem cell allograft and to compare with existing regimens. Methods: Nine consecutive patients with severe corneal limbal stem cell deficiency from chemical burn or aniridia underwent corneal limbal stem cell allograft (LSA) with concomitant penetrating keratoplasty (PK). Eight of the nine patients also had prior amniotic membrane transplantation (AMT). All patients received a triple-drug regimen for systemic immunosuppression consisting of mycophenolate mofetil (MMF), cyclosporine (CsA) and prednisone. The protocol is characterized by a staggering dosing regimen with MMF starting at 1 month preoperatively and continued for at least 1 year; while CsA and prednisone were started 3 days preoperatively and continued for 6 months in a tapered manner. Results: At a mean follow-up period of 12.6 months (ranging from 3 to 27 months), best-corrected visual acuity improved in 8/9 (89%) patients, and ocular surface stabilized in 6/7 (86%) among the 7 survived grafts. Irreversible graft rejection occurred in 1/9 (11%) patients and infection in 1/9 (11%) patients which resulted in graft failure. The percentage of both corneal and limbal allografts that survived the first year is 7/9 (78%); all that reached the 2nd year survived (4/4, 100%); and all that reached 3rd year survived (2/2, 100%). The outcome of this study compares favorably with existing regimens reported in the literature. The regimen was reasonably tolerated as no patients developed systemic infection, hepatic toxicity or changes in renal function. One patient did develop transient borderline hyperglycemia, and another patient gastrointestinal intolerance to MMF, which resolved after substituting it with azathioprine. Conclusion: This new triple-drug regimen for systemic immunosuppression for corneal limbal stem cell and corneal allograft is efficacious and well tolerated. It compares favorably with existing regimens.
This PDF is available to Subscribers Only