Subconjuntival Triamcinolone Added To Topical Prednisolone Plus Intravenous Methylprednisolone Pulse In Acute Endothelial Graft Rejection Treatment

Abstract

Purpose: : To describe whether the addition of subconjuntival Triamcinolone as adjunct treatment to topical Prednisolone plus Intravenous Methylprednisolone pulse in the treatment of endothelial graft rejection improves the outcome, as well as its safety.

Methods: : Patients with acute endothelial graft rejection with diagnosis of Keratoconus and Bullous keratopathy treated with a subconjuntival injection of 20mg of Triamcinolone, topical 1% Prednisolone and a single Intravenous injection of 500mg Methylprednisolone pulse were included. Follow-up was at day 1, first and second week, one and two months. Reversion rate and adverse effects were analyzed

Results: : Reversion rate of acute endothelial graft rejection was 100% (9/9 patients) at 1.62 weeks (+/-0.46weeks). 22% of the patients (2/9) had ocular hypertension, they were managed with topical drugs, and no patient required glaucoma surgery. At two months, intraocular pressure increase 2.89mmHg (+/- 1.15) (20.24%). No patient needed glaucoma surgery. There were minimal visual acuity changes at the end of the treatment. At two months one patient had a new episode of acute endothelial graft rejection.

Conclusions: : Patients with acute endothelial graft rejection receiving subconjuntival Triamcinolone, topical Prednisolone and Intravenous Methylprednisolone pulse improve several outcomes of rejection. It’s safe at two months follow-up and it doesn’t prevent new endothelial graft rejection episodes. More patients are needed to compare with previous results.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • cornea: endothelium • corticosteroids