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Jong Joo Lee, Mee Kum Kim, Won Ryang Wee; Adverse effects of Systemic Cyclosporin A in High-risk Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3095.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the adverse effects of oral cyclosporine (CSA) after high-risk corneal transplantation
Eighty high-risk penetrating keratoplasties with postoperative oral CSA were analyzed retrospectively including cumulative doses and durations of CSA administration, adverse effects caused by oral CSA and frequency of herpes keratitis. High risk group was defined as history of graft rejection, three or more quadrants of vascularization, presence or history of intraocular inflammation. An initial dose of 5mg/kg per day was given for 3-7 days, followed by 2.5mg/kg per day for about 1 month. The target trough level was 100 to 150ng/ml. The incidence of herpes keratitis among seventy four patients who did not take cyclosporine after penetrating keratoplasty was also checked and compared.
The corneal grafts in high-risk recipient beds survived in 47.5% during a mean follow up period of 707 days, and oral CSA was administered for an average of 197 days postoperatively. The incidence of systemic adverse effects of CSA was 45.0%. Hypertension was detected in 15.0%, Liver enzymes were elevated in 10.0%, gastrointestinal complaints such as heartburn or dyspepsia were recorded in 8.8%, Serum creatinine increased in 7.5%, absolute neutrophil count (ANC) decreased in 5.0%, and hirsutism appeared in 3.8%. All the adverse events were reported even if CSA trough levels were kept within a normal range. Hypertension was noticeable at day 159 (median, 14-217), cumulative doses of 445.5mg/kg (median, 187.3-954.2mg/kg), and ANC decreased at day 220 (median, 109-263), cumulative doses of 888.4mg/kg (median, 514.6-1079.8mg/kg). All three patients with hirsutism complained about their appearances between 30 and 100 days. Serum liver enzymes and creatinine could increase irrespective of whether the drug was administered for long or short periods. Herpes keratitis occurred more frequently in cases with oral CSA than those without oral CSA after corneal transplantation (p=0.000).
The adverse effects of CSA can occasionally occur during the oral administration after high-risk keratoplasty, and common problems are blood pressure elevation, liver and kidney function abnormality, and gastrointestinal discomforts. The incidence of herpes keratitis rises when CSA is taken postoperatively. It is also noted that absolute neutrophil count could go down as cumulative doses of CSA mount up after about 3 months or more.
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