Tacrolimus Eye Drops as Adjunct Therapy in Severe Corneal Endothelial Rejection Refractory to Corticosteroids
Tacrolimus Eye Drops as Adjunct Therapy in Severe Corneal Endothelial Rejection Refractory to Corticosteroids
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DOI：
10.1097/ico.0000000000001298
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发表时间：
2017-10-01
期刊：
影响因子：
2.8
通讯作者：
Djalilian, Ali R.
中科院分区：
文献类型：
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作者：
Ghaffari, Reza;Ghassemi, Hamed;Djalilian, Ali R.
目的：目的评价他克莫司滴眼液治疗皮质激素治疗无效的穿透性角膜移植术后严重角膜内皮排斥反应的安全性和有效性。在该前瞻性干预性病例系列中，11例患者的11只眼被评估为严重角膜内皮排斥反应，对局部、局部和全身皮质类固醇反应不足，用0.01%或0.05%他克莫司滴眼液每日4次治疗。排斥反应，视觉功能和并发症的发展迹象的改善monitored.Results：干预前的类固醇治疗的持续时间为8.1 +/- 1.4天（范围= 7-11）。患者随后给予局部他克莫司0.01%或0.05%qid。至临床改善的时间为10.3 +/- 3.4天（范围= 3-17）。至排斥逆转的时间为27.8 +/- 16.3天（范围= 7-52）。3个月后，10名患者（90.8%）表现出临床改善，5名患者（45.4%）实现了移植物透明度的完全恢复。在反应性病例中，类固醇治疗在60.2 +/- 19.7天（范围= 36-93）后成功逐渐减少。最佳矫正视力从1.7 +/- 0.9提高到0.8 +/- 0.5 logMAR（P = 0.0016）。报告的副作用包括刺痛滴注和点状上皮keratopathy.Conclusions：他克莫司滴眼液可能能够发挥一个连续的治疗作用，在患者严重的角膜内皮排斥反应难治性常规类固醇治疗。需要对照研究来进一步研究他克莫司在这种情况下的作用。
Purpose: To evaluate the safety and efficacy of tacrolimus eye drops as adjunctive therapy in the treatment of severe corneal endothelial rejection after penetrating keratoplasty refractory to corticosteroids.Methods: In this prospective interventional case series, 11 eyes of 11 patients assessed for severe corneal endothelial rejection, with an inadequate response to topical, local, and systemic corticosteroids, were treated with either 0.01% or 0.05% tacrolimus eye drops 4 times daily. Improvement in signs of rejection, visual function, and development of complications were monitored.Results: The duration of steroid treatment before intervention was 8.1 +/- 1.4 days (range = 7-11). Patients were subsequently administered topical tacrolimus 0.01% or 0.05% qid. The time to clinical improvement was 10.3 +/- 3.4 days (range = 3-17). The time to rejection reversal was 27.8 +/- 16.3 days (range = 7-52). After 3 months, 10 patients (90.8%) demonstrated clinical improvement, and complete restoration of graft clarity was achieved in 5 patients (45.4%). In responsive cases, steroid therapy was successfully tapered off after 60.2 +/- 19.7 days (range = 36-93). The best spectacle-corrected visual acuity improved from 1.7 +/- 0.9 to 0.8 +/- 0.5 logMAR (P = 0.0016). Reported side effects included stinging on drop instillation and punctate epithelial keratopathy.Conclusions: Tacrolimus eye drops may be able to play an adjunctive therapeutic role in patients with severe corneal endothelial rejection refractory to conventional steroid treatment. Controlled studies are needed to further investigate the role of tacrolimus in this setting.