Cyclosporine less effective than corticosteroids in preventing corneal graft rejection

Topical cyclosporine is not as effective as prednisolone for preventing graft rejection in low-risk corneal transplant patients, a prospective study suggests.

Marianne O. Price, PhD, and Francis W. Price Jr., MD, evaluated the efficacy of topical cyclosporine 0.05% for inhibiting graft rejection in 46 patients treated with cornea transplant for keratoconus, Fuchs' dystrophy or nonherpetic, nonvascularized corneal scarring. All patients initially used topical prednisolone acetate 1% four times daily, tapered until 13 weeks after corneal transplant. Treatment with topical cyclosporine 0.05% four times daily was begun either 1 or 10 weeks after the transplant and continued for 1 year. One subgroup was randomly assigned to receive "pulsed" prednisolone acetate 1%, four times a day for 4 days every 6 weeks.

For comparison, the researchers also retrospectively collected data for a historical control group of penetrating keratoplasty patients treated before initiation of the study. This control group included 30 keratoconus patients and 30 Fuchs' dystrophy patients treated with 7 months of corticosteroids.

The researchers found that patients in both study groups experienced significantly more episodes of immunologic graft rejection than the historical control group (P < .0001). In addition, patients treated with cyclosporine and pulsed prednisolone had a significantly higher incidence (P = .04) of rejection than patients treated with cyclosporine alone, according to the study.

"In all three cyclosporine treatment groups, the incidence of rejection was low while the [patients] were concurrently using topical corticosteroids but increased dramatically after corticosteroids were discontinued," the authors said.

The study is published in the October issue of Ophthalmology.