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Eubee B Koo, Allister Gibbons, Victor L Perez; Management of early acute rejection of keratolimbal allografts: a case series.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6315.
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While systemic immunosuppression is often required for long-term graft survival following keratolimbal allograft, the use of pulsed intravenous methylprednisolone in the face of early acute rejection is not well described. We report the presentation, management and outcomes of patients at our institution following early acute rejection after keratolimbal allograft (KLAL) surgery.
The medical records of all patients who underwent a KLAL at Bascom Palmer Eye Institute since 2006 were retrospectively reviewed for the occurrence of an acute rejection episode occurring within the 3-month post-operative period. Three cases were identified and reviewed for this series.
All patients presented with an episode of rejection within one month of undergoing KLAL. All of them were under 50 years of age and on triple immunosuppressive regimen; however, there were documented issues with compliance. After treatment with pulsed intravenous methylprednisolone, along with education on medication adherence, KLAL function was restored in all three cases.
While compliance with immunosuppression is crucial in preventing graft rejection after KLAL, in cases where an early acute rejection episode occurs, prompt recognition and aggressive management with pulsed intravenous steroids can preserve graft function.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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