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Ricardo Y. Abe, Livia Maria D. Freire, Rosane S. Castro, Rodrigo Pessoa C. Lira, Carlos E. Arieta; Corneal Endothelial Rejection after Penetrating Keratoplasty treated with Intravenous and Topic Corticosteroid. One Year Follow Up. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2376.
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To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid.
Interventional, prospective, non-comparative case series study evolving 24 PKP patients in one year follow up, who presented initial episode of corneal endothelial rejection. Characteristics of the patient, study eye, surgical procedure and information about postoperative follow up were examined for their association with the graft outcome. The patients were submitted to 500 mg IV injection of methylprednisolone (2 doses with 1 week interval) in association with topical prednisolone. Main outcome measures included VA before treatment in comparison to the most recent follow-up and corneal edema regression. Second outcome included new rejections and graft failure during follow up. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors.
A total of 24 eyes from 24 patients (9 male and 14 female with mean age, 46 +/- 19 years) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). 19 in 24 patients recovered the previous VA and presented corneal edema regression, 9 in 24 patients presented new endothelial rejections and graft failure occurred in 5 of 24 eyes. Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.042). Patients with previous anterior segment surgery had worse VA recovery and more graft failure (p<0.042). The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients.
Methylprednisolone (2 doses of 500 mg IV) in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment.
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