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Kyoko Hatano, Katsuya Yamazoe, Takefumi Yamaguchi, Masahiro Omoto, Seika Den, Kenji Konomi, Jun Shimazaki; Efficacy and Safety of Systemic Tacrolimus in High-risk Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):375.
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To assess the efficacy and safety of systemic tacrolimus administration for patients undergoing high-risk penetrating keratoplasty (PKP).
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.
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.
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.
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