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Topical cyclosporine in high-risk corneal transplants
M W Belin1, C S Bouchard, S Frantz
1George Washington University Medical Center, Department of Ophthalmology, Washington, DC.
Abstract:
Cyclosporine (cyclosporin A, CsA) is a selective T-cell immunosuppressant that works primarily through inhibition of both antigen presentation and lymphokine production. It has dramatically improved the prognosis for solid organ transplantation. Significant nephrotoxicity has been associated with its systemic use. Topical CsA 2% was used in 11 high-risk corneal transplant patients (8 men; 3 women; average age, 44 years). Ten (91%) of 11 corneas remained clear at an average follow-up of 16 months (range, 6-24 months). All patients had transient epithelial keratitis. Systemic whole blood levels of CsA measured by high-performance liquid chromatography (HPLC) ranged from 14 to 64 ng/ml. All previous reports on the use of topical CsA in high-risk corneal transplant patients have not detected systemic CsA levels.
Insights
Topical 2% cyclosporine (CsA) effectively maintained corneal clarity in 91% of high-risk transplant patients. This study detected systemic CsA levels, unlike previous reports, suggesting potential systemic absorption with topical ocular use.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Cyclosporine (CsA) is a T-cell immunosuppressant vital for organ transplantation.
- Systemic CsA use is linked to significant nephrotoxicity.
- Topical CsA offers a potential alternative for ocular conditions.
Purpose of the Study:
- To evaluate the efficacy and safety of topical 2% CsA in high-risk corneal transplant patients.
- To determine systemic CsA absorption levels following topical ocular administration.
Main Methods:
- 11 high-risk corneal transplant patients received topical 2% CsA.
- Corneal clarity was monitored over an average follow-up of 16 months.
- Systemic CsA blood levels were measured using HPLC.
Main Results:
- 91% of corneas remained clear at follow-up.
- All patients experienced transient epithelial keratitis.
- Systemic CsA levels ranged from 14 to 64 ng/ml, a finding not reported previously.
Conclusions:
- Topical 2% CsA demonstrates high efficacy in preserving corneal grafts in high-risk patients.
- The detection of systemic CsA levels warrants further investigation into its ocular pharmacokinetics and potential systemic effects.