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FF Behar-Cohen, M Halhal, D BenEzra, D Chauvaud, G Renard; Reversal of Corneal Graft Rejection by Iontophoresis of Methylprednisolone . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2214.
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Purpose: Study the therapeutic effects of iontophoresis on acute corneal graft rejection reactions. Methods: Eighteen consecutive adult patients presenting with acute corneal graft rejection in one eye were included in this study after an informed consent was obtained. Acute corneal graft rejection was diagnosed upon the following signs: previous clear graft and clear vision, sudden segmental or generalized corneal edema with a significant drop of visual acuity, anterior chamber reaction with keratic precipitates and presence of cells and flare in the anterior chamber. For iontophoresis, the Eyegate (Optis,France) device was used. Topical anesthesia was obtained by instillation of Tetracaïne drops. Methylprednisolone hemisuccinate (HMP) 62.5mg/ml was infused in the ocular probe container and a current power of 1.5 mA was applied for 4 minutes at day 0, 1 and 2. The treated eye was patched for six hours following treatment. The patients were then instructed to start topical 0.1% phosphate dexamethasone 3 times a day at day 0, 1 and 2 followed by a regimen of 6 drops/day and dexa ointment at bed time from day 3 onwards. The response to treatment was monitored by assessing clinical signs with a special emphasis on corneal graft transparency and visual acuity. Results: The mean follow-up time after the 18 included patients was 10.6 months with a range of 2 to 26 months. Twenty four to 48 hours after the last iontophoresis treatment, decreased corneal edema were observed in 88% of the cases and at the 10 days, sixteen of the 18 patients demonstrated a complete reversal of the rejection processes. Two of the patients did not improved. The mean visual acuity of all 18 patients during this visit was 0.3 ± 0.17 as compared to a mean of 0.06±0.04 on presentation. The clinical improvement recorded at day 10 was maintained also on day 60 and later. No significant side-effects due to iontophoresis application were observed. The extended follow up of these patients will be presented and discussed. Conclusions: Iontophoresis of MPH can be considered as an alternative to pulse intravenous therapy for the management of acute corneal graft rejection. Patients who are prone to develop severe secondary complications following the administration of systemic corticosteroids would probably benefit most.
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