Systemic cyclosporine ineffective for suppressing immunologic rejection in high-risk PK

Am J Ophthalmol. 2011;152(1):33-39.

Administering systemic cyclosporine in high-risk corneal transplantation procedures did not suppress immunologic rejection, a study found.

“The relatively high incidence of systemic side effects observed with [systemic cyclosporine] administration indicates that this drug should not be recommended for use in corneal transplant recipients, especially older recipients,” the study authors said.

The study included 39 eyes of 39 patients divided into two groups: systemic cyclosporine (20 patients) and controls (19 patients). Mean age was 67.3 years.

Thirty-two patients underwent penetrating keratoplasty alone; seven patients had PK combined with cataract surgery.

Systemic cyclosporine was administered for at least 6 months. Graft clarity, endothelial rejection, and local and systemic complications were the main outcome measures.

Cyclosporine administration was discontinued in seven of 20 patients: two at the patient’s request, one due to the development of infectious keratitis, and four due to systemic side effects including eczema, back pain, chest pain and nausea.

Complications developed in 11 eyes (55%) of the cyclosporine group and nine eyes (47.4%) of the control group, including glaucoma, infectious keratitis, persistent epithelial defect and traumatic wound dehiscence. There was no significant difference between the two groups in the incidence of complications.

Patients were considered to be at high risk for rejection if they had corneal neovascularization in more than one quadrant or if they had a history of corneal grafting.