Abstract：
BACKGROUND: To evaluate the efficacy of the topical administration of immunosuppressants and corticosteroids in tapering doses in the management of patients with high-risk keratoplasty.
METHODS: One hundred and six patients treated with topical immunosuppressants (50 eyes in the FK506 group and 56 eyes in the CsA group) and corticosteroid eye drops in tapering doses were enrolled in the study. The rates of rejection episodes, irreversible rejection, graft survival, and related influential factors were evaluated.
RESULTS: The mean follow-up period was 48.1 ± 7.9 months (range, 36-60 months). The rates of rejection episodes and irreversible rejection were 14.0% and 6.00% in the FK506 group and 37.5% and 7.1% in the CsA group, respectively. Kaplan-Meier survival analysis demonstrated a significantly higher graft survival rate in the FK506 group (81.6%±5.3%, 71.1%±6.3%) compared with that in the CsA group (71.1%±6.3%, 57.5%±7.5%) at 3 and 5 years after surgery (P = 0.006). Multivariate logistic regression revealed that preoperative risk score ≥ 3 (P = 0.016) and endothelial immune rejection (P = 0.033) were risk factors associated with graft survival.
CONCLUSIONS: Topical administration of tacrolimus and corticosteroids in tapering doses is effective in decreasing the incidence of immune rejection in high-risk keratoplasty. Careful instruction of patients on the reasonable use of topical tacrolimus is critical to avoid immune rejection induced by sudden discontinuation of medication.
METHODS: One hundred and six patients treated with topical immunosuppressants (50 eyes in the FK506 group and 56 eyes in the CsA group) and corticosteroid eye drops in tapering doses were enrolled in the study. The rates of rejection episodes, irreversible rejection, graft survival, and related influential factors were evaluated.
RESULTS: The mean follow-up period was 48.1 ± 7.9 months (range, 36-60 months). The rates of rejection episodes and irreversible rejection were 14.0% and 6.00% in the FK506 group and 37.5% and 7.1% in the CsA group, respectively. Kaplan-Meier survival analysis demonstrated a significantly higher graft survival rate in the FK506 group (81.6%±5.3%, 71.1%±6.3%) compared with that in the CsA group (71.1%±6.3%, 57.5%±7.5%) at 3 and 5 years after surgery (P = 0.006). Multivariate logistic regression revealed that preoperative risk score ≥ 3 (P = 0.016) and endothelial immune rejection (P = 0.033) were risk factors associated with graft survival.
CONCLUSIONS: Topical administration of tacrolimus and corticosteroids in tapering doses is effective in decreasing the incidence of immune rejection in high-risk keratoplasty. Careful instruction of patients on the reasonable use of topical tacrolimus is critical to avoid immune rejection induced by sudden discontinuation of medication.
摘要：
背景：评估局部施用逐渐减少剂量的免疫抑制剂和皮质类固醇在高危角膜移植术患者治疗中的疗效。
方法：本研究纳入了106例接受局部免疫抑制剂治疗的患者（FK506组50只眼，CsA组56只眼）和逐渐减少剂量的皮质类固醇滴眼液。拒绝事件的发生率，不可逆的排斥,移植物存活，并对相关影响因素进行了评价。
结果：平均随访期为48.1±7.9个月（范围，36-60个月）。FK506组排斥反应和不可逆排斥反应发生率分别为14.0%和6.00%,CsA组分别为37.5%和7.1%,分别。Kaplan-Meier生存分析表明，FK506组的移植物存活率显着提高（81.6％±5.3％，71.1％±6.3％）与CsA组（71.1％±6.3％，手术后3年和5年的57.5％±7.5％）（P=0.006）。多因素logistic回归分析显示，术前风险评分≥3分（P=0.016）和内皮免疫排斥反应（P=0.033）是影响移植物存活的危险因素。
结论：在高危角膜移植术中，以逐渐减少的剂量局部给药他克莫司和皮质类固醇可有效降低免疫排斥的发生率。仔细指导患者合理使用他克莫司对于避免突然停药引起的免疫排斥反应至关重要。
方法：本研究纳入了106例接受局部免疫抑制剂治疗的患者（FK506组50只眼，CsA组56只眼）和逐渐减少剂量的皮质类固醇滴眼液。拒绝事件的发生率，不可逆的排斥,移植物存活，并对相关影响因素进行了评价。
结果：平均随访期为48.1±7.9个月（范围，36-60个月）。FK506组排斥反应和不可逆排斥反应发生率分别为14.0%和6.00%,CsA组分别为37.5%和7.1%,分别。Kaplan-Meier生存分析表明，FK506组的移植物存活率显着提高（81.6％±5.3％，71.1％±6.3％）与CsA组（71.1％±6.3％，手术后3年和5年的57.5％±7.5％）（P=0.006）。多因素logistic回归分析显示，术前风险评分≥3分（P=0.016）和内皮免疫排斥反应（P=0.033）是影响移植物存活的危险因素。
结论：在高危角膜移植术中，以逐渐减少的剂量局部给药他克莫司和皮质类固醇可有效降低免疫排斥的发生率。仔细指导患者合理使用他克莫司对于避免突然停药引起的免疫排斥反应至关重要。
