Systemic cyclosporine in high-risk keratoplasty. Short- versus long-term therapy.

BACKGROUND: In high-risk keratoplasty, the failure rate from rejection is high, especially in the early postoperative period. If rejection could be prevented during this period, then ultimately a degree of immunologic privilege may be re-established, resulting in long-term graft survival. Cyclosporine (CSA) given systemically prevents graft rejection, but because of the potential side effects and cost, the duration of treatment is an important factor. The author examines the effectiveness of short- and long-term CSA regimens in preventing irreversible graft rejection.

METHODS: Forty-three patients with high-risk corneas (vascularization in 3 or 4 quadrants and > 16 stromal vessels) received corneal grafts and systemic CSA. Fourteen patients received the drug for 12 months and 29 for a shorter period of 4 to 6 months. A similar high-risk group of 37 patients received no systemic medication.

RESULTS: In the control group, 23 grafts (62.2%) irreversibly rejected, compared with 9 (31.0%) and 1 (7.1%) in the short- and long-term CSA groups, respectively. The grafts of patients receiving CSA had a significantly better survival rate (P = 0.0005) than those in the control group. If time of CSA treatment also was considered, significance increased (P = 0.00008).

CONCLUSIONS: Systemic CSA significantly reduces failure from irreversible rejection in high-risk keratoplasty, but for maximal effect, a 12-month period of treatment is necessary.