Corticosteroids in corneal graft rejection: double versus single pulse therapy

In a previous study, we reported that a single intravenous pulse of 500 mg of methylprednisolone is more effective than oral prednisone in reversing rejection in patients who present early with severe endothelial rejection. In addition, the grafts that survived were less likely to undergo a further rejection episode. This study investigates whether a second pulse given at 24 h (n = 31) or at 48 h (n = 29) has any advantage over a single pulse (n = 30). All three treatment regimens were equally effective in reversing rejection (74.2%, 79.3%, and 83.3%, respectively), and there was no statistical difference in graft survival. An additional pulse therefore appears to offer no advantage over single pulse therapy. In high-risk grafts, current therapy has been reported to be less effective in reversing graft rejection. This study showed no significant difference between high- and low-risk grafts, indicating that pulse therapy may have a particular role in these difficult cases.