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A Joseph, D Raj, R Powell, HS Dua; Efficacy of Tacrolimus in the Management of High-risk Corneal Grafts . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2222.
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Purpose:To assess the efficacy of the immunosuppressive agent tacrolimus in the management of high-risk corneal grafts. Methods:35 patients (36 eyes) 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). 2 patients had repeat grafts in the same eye following failure of the first graft. Graft rejection and survival were the main outcome measures. The median follow up was 20 months. Tacrolimus was stopped 18 months post-keratoplasty if rejection free, or 1 year after the last rejection episode. Results:4 patients discontinued tacrolimus due to side-effects and a further 4 patients had graft failure not associated with rejection. Of the remaining 27 patients (28 eyes), one patient who had 3 previous rejected grafts and 4 quadrant stromal vascularisation pre-operatively, had irreversible graft rejection 1 month postoperatively; 5 patients had reversible graft rejection whilst on tacrolimus. The corneal grafts remain clear in 27 eyes, of whom 12 have successfully stopped treatment (median follow up 31months). 3 patients had reversible graft rejection after stopping tacrolimus and one patient had non rejection related graft failure 3 months after stopping tacrolimus. Conclusion:Of the 31 patients on tacrolimus, 6 patients (19%) experienced rejection episodes, of whom one had rejection related graft failure. Use of tacrolimus was associated with a reduced incidence of rejection related failure in high-risk corneal grafts.
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