Efficacy and Safety of Systemic Tacrolimus in High-risk Penetrating Keratoplasty

Abstract

Purpose: : To assess the efficacy and safety of systemic tacrolimus administration for patients undergoing high-risk penetrating keratoplasty (PKP).

Methods: : Nine eyes of 9 patients (mean age:57.2±13.0 years) who had repeated PKP for decompensated grafts despite with the use of systemic cyclosporine (CsA) in previous surgeries were treated with systemic tacrolimus. Blood trough level was maintained at approximately 6 ng/ml for at least 6 months after the surgery unless side effects developed.

Results: : The original diseases were bullous keratopathy in 6 eyes, keratoconus in one eye, and others in 2 eyes. All had history of previous PKP (mean 2.2± 0.7 times) and systemic CsA was used with topical corticosteroids. Seven of 9 patients had graft rejection episodes in previous PKP with a mean duration of 28.0 ± 33.4 months postoperatively. Duration of clear corneal graft was 31.2 months. Mean duration of tacrolimus administration was 9.7 ± 10.9 months. No patient had graft rejection during a mean follow-up period of 29.1 ± 26.0 months, and duration of clear corneal graft was 11.8 months. Two grafts remained clear for more than 2 years after discontinuation of tacrolimus. Two patients developed side effects; one had renal dysfunction, and the other had muscle pains and sustained fatigue. The side effects diminished after discontinuation of tacrolimus.

Conclusions: : Treatment with systemic tacrolimus seemed to be safe and effective for suppressing immunological rejection and for prolonging graft survival in patients with high-risk PKP.

Keywords: transplantation