Monitoring ensures safety of immunosuppression after ocular surface stem cell transplantation

Proper protocols are essential to the safety and efficacy of systemic immunosuppression after ocular surface stem cell transplantation, a study found.

“In general, ophthalmologists are not trained in administering systemic immunosuppression protocols or in the management of health issues that are introduced by those medications,” the study authors said. “A deeper understanding of the methodology in tailoring immunosuppression regimens to each patient will assist corneal surgeons in achieving an ideal balance between too little immunosuppression, which can lead to allograft rejection, versus too much, which can lead to medication side effects and patient adverse events.”

The retrospective study included 225 eyes of 136 patients with a mean age of 43.6 years who underwent ocular surface stem cell transplantation with systemic immunosuppression. The mean duration of follow-up after transplantation was 53.9 months. Immunosuppression was used for a mean of 42.1 months.

The most common immunosuppression protocol, used in 102 patients, was tacrolimus, mycophenolate mofetil and short-duration prednisone. In addition, prophylactic valganciclovir and trimethoprim/sulfamethoxazole, or dapsone if subjects had sulfa allergy, were used. Twenty-two patients had a regimen of azathioprine, cyclosporine and prednisone, and 12 patients used only two agents because of baseline health issues.

Data showed that 105 patients (77.2%) had a stable ocular surface at final follow-up. Three severe adverse events occurred in two patients (1.5%). Twenty-one minor adverse events occurred in 19 patients (14%). Of the 21 patients experiencing adverse events, 10 (47.6%) had systemic comorbidities at baseline, the authors said.

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Source:

Cornea. 2012;31(6):655-661.