May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Subconjunctival Injection of Triamcinolone Acetonide in the Treatment of Endothelial Corneal Allograft Rejection
Author Affiliations & Notes
  • D. C. Costa
    Ophthalmology, UNICAMP, Sao Paulo, Brazil
  • R. S. Castro
    Ophthalmology, UNICAMP, Sao Paulo, Brazil
  • N. Kara-Jose
    Ophthalmology, UNICAMP, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships  D.C. Costa, None; R.S. Castro, None; N. Kara-Jose, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 1147. doi:https://doi.org/
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      D. C. Costa, R. S. Castro, N. Kara-Jose; Subconjunctival Injection of Triamcinolone Acetonide in the Treatment of Endothelial Corneal Allograft Rejection. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1147. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To assess the safety and effectiveness of the treatment of corneal endothelial allograft rejection with subconjunctival injection of 20 mg triamcinolone acetonide and topical 1% prednisolone acetate when compared to a single intravenous pulse of 500 mg methylprednisolone and topical 1% prednisolone acetate.

Methods: : All keratoplasty patients with the first acute episode of corneal endothelial rejection seen at the Ophthalmology Department of the State University of Campinas (UNICAMP), Brazil, from November 2005 until February 2006, were treated with subconjunctival injection of 20 mg triamcinolone acetonide and topical 1% prednisolone acetate. Patients were matched by age and diagnosis of corneal transplantation with patients previously treated in a standard protocol of a single intravenous pulse of 500 mg of methylprednisolone and topical 1% prednisolona acetate. Outcomes analyzed were success at the end of one year of follow-up, visual acuity (VA) at one year of follow-up and intra-ocular pressure (IOP) at one month of treatment.

Results: : Sixteen patients presented first acute episode of corneal endothelial allograft rejection during the recruitment time and received subconjunctival injection of 20 mg triamcinolone acetonide in addition to topical prednisolone acetate 1% and were matched by age and diagnosis of corneal transplantation with 16 patients treated with a single intravenous pulse of 500 mg of methylprednisolone and topical 1% prednisolone acetate. Intra-ocular pressure rised in both groups but was statistically significant (p<0.05) only in the group treated with triamcinolone (baseline = 13.38 ± 3.24 mmHg; one month IOP = 18.31 ± 6.53 mmHg). Visual acuity had a statistically significant improvement only in the group treated with triamcinolone (baseline VA = 1.27 ± 0.54 logMAR; one year VA = 0.74 ± 0.67 logMAR) but it could not be proven that triamcinolone led to higher rates of reversion of the acute episode of endothelial corneal rejection (p=.063).

Conclusions: : Subconjunctival injection of 20 mg triamcinolone acetonide combined with topical 1% prednisolone acetate was shown to be as effective as a single intravenous pulse of 500 mg of methylprednisolone combined with topical 1% prednisolone acetate in the treatment of the first acute episode of corneal endothelial allograft rejection in this case-control study, leading to better visual acuity levels after one year of corneal rejection, but also to higher levels of intra-ocular pressure. Further studies need to be conducted to verify its safety and effectiveness in larger populations.

Keywords: transplantation • corticosteroids 
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