Efficacy of mycophenolate mofetil combined with topical 0.05% tacrolimus in high-risk keratoplasty: 1-year cohort study.

IF 1.9 4区医学 Q2 OPHTHALMOLOGY International journal of ophthalmology Pub Date : 2024-12-18 eCollection Date: 2024-01-01 DOI:10.18240/ijo.2024.12.10

Jin-Yu Zhang, Kang Yu, Xiu-Ying Jiang, Jia-Xin Liang, Shi-You Zhou

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Abstract

Aim: To investigate the efficacy of systemic mycophenolate mofetil (MMF) as an adjunct in combination with topical tacrolimus (FK506) and corticosteroid eyedrops for preventing corneal graft rejection after high-risk keratoplasty (HRK).

Methods: In this cohort study, 55 consecutive patients (55 eyes) from an eye center who met the criteria of HRK were included. The definition for HRK includes large grafts of no less than 9 mm diameter, vascularized cornea of two or more quadrants, regrafting, or eccentric grafts. After penetrating keratoplasty, 25 patients treated with systemic MMF in combination with 0.05% FK506 and tapering corticosteroid eyedrops were enrolled in Group 1 from October 2019. Thirty patients receiving postoperative treatment with 0.05% FK506 and tapering corticosteroid eyedrops alone were enrolled in Group 2 from January 2018 to September 2019. All participants were closely monitored after surgery, and episodes of graft rejection and relevant clinical data were collected and assessed over a one-year follow-up period.

Results: After a follow-up of 9.6±3.2mo, graft rejection episodes occurred in 4 cases (16%) in Group 1 and 18 cases (60%) in Group 2. One reversible and 3 irreversible graft rejections occurred in Group 1, while 3 reversible and 15 irreversible rejections occurred in Group 2. Kaplan-Meier analysis revealed that 82.5% of grafts in Group 1 and 37.1% in Group 2 did not experience corneal graft rejection (P<0.01, log-rank test). The clear graft survival rate was 83.6% in Group 1 and 36.7% in Group 2 (P<0.01, log-rank test) within one year of follow-up. No severe systemic side effects were observed in either group during the follow-up period.

Conclusion: The triple treatment regimen consisting of MMF, topical FK506, and corticosteroid eyedrops represents a promising strategy for effectively preventing graft rejection and improving graft survival in patients with HRK.

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霉酚酸酯联合局部0.05%他克莫司在高危角膜移植术中的疗效：1年队列研究。

目的：探讨全身麦考酚酸酯（MMF）联合外用他克莫司（FK506）和皮质类固醇滴眼液预防高危角膜移植术（HRK）后角膜移植排斥反应的疗效。方法：本队列研究纳入来自眼科中心符合HRK标准的55例连续患者（55只眼）。HRK的定义包括直径不小于9毫米的大角膜移植、两个或两个以上象限的带血管角膜移植、再移植或偏心移植。穿透性角膜移植术后，25例患者接受全身MMF联合0.05% FK506和锥形皮质类固醇滴眼液治疗，从2019年10月开始纳入第一组。2018年1月至2019年9月，30例患者接受术后单独使用0.05% FK506和锥形皮质类固醇滴眼液治疗。术后密切监测所有参与者，在一年的随访期间收集和评估移植物排斥事件和相关临床数据。结果：随访9.6±3.2个月，1组4例（16%）发生排斥反应，2组18例（60%）发生排斥反应。1组发生1次可逆和3次不可逆的移植排斥反应，2组发生3次可逆和15次不可逆的移植排斥反应。Kaplan-Meier分析显示，第1组82.5%的移植物和第2组37.1%的移植物没有发生角膜排斥反应(pppp结论：MMF、外用FK506和皮质类固醇滴眼液的三联治疗方案是一种有效预防HRK患者移植排斥反应和提高移植物存活率的有希望的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of ophthalmology Medicine-Ophthalmology

CiteScore

2.50

自引率

7.10%

发文量

3141

审稿时长

4-8 weeks

期刊介绍： · International Journal of Ophthalmology-IJO (English edition) is a global ophthalmological scientific publication and a peer-reviewed open access periodical (ISSN 2222-3959 print, ISSN 2227-4898 online). This journal is sponsored by Chinese Medical Association Xi’an Branch and obtains guidance and support from WHO and ICO (International Council of Ophthalmology). It has been indexed in SCIE, PubMed, PubMed-Central, Chemical Abstracts, Scopus, EMBASE , and DOAJ. IJO JCR IF in 2017 is 1.166. IJO was established in 2008, with editorial office in Xi’an, China. It is a monthly publication. General Scientific Advisors include Prof. Hugh Taylor (President of ICO); Prof.Bruce Spivey (Immediate Past President of ICO); Prof.Mark Tso (Ex-Vice President of ICO) and Prof.Daiming Fan (Academician and Vice President, Chinese Academy of Engineering. International Scientific Advisors include Prof. Serge Resnikoff (WHO Senior Speciatist for Prevention of blindness), Prof. Chi-Chao Chan (National Eye Institute, USA) and Prof. Richard L Abbott (Ex-President of AAO/PAAO) et al. Honorary Editors-in-Chief: Prof. Li-Xin Xie(Academician of Chinese Academy of Engineering/Honorary President of Chinese Ophthalmological Society); Prof. Dennis Lam (President of APAO) and Prof. Xiao-Xin Li (Ex-President of Chinese Ophthalmological Society). Chief Editor: Prof. Xiu-Wen Hu (President of IJO Press). Editors-in-Chief: Prof. Yan-Nian Hui (Ex-Director, Eye Institute of Chinese PLA) and Prof. George Chiou (Founding chief editor of Journal of Ocular Pharmacology & Therapeutics). Associate Editors-in-Chief include: Prof. Ning-Li Wang (President Elect of APAO); Prof. Ke Yao (President of Chinese Ophthalmological Society) ; Prof.William Smiddy (Bascom Palmer Eye instituteUSA) ; Prof.Joel Schuman (President of Association of University Professors of Ophthalmology,USA); Prof.Yizhi Liu (Vice President of Chinese Ophtlalmology Society); Prof.Yu-Sheng Wang (Director of Eye Institute of Chinese PLA); Prof.Ling-Yun Cheng (Director of Ocular Pharmacology, Shiley Eye Center, USA). IJO accepts contributions in English from all over the world. It includes mainly original articles and review articles, both basic and clinical papers. Instruction is Welcome Contribution is Welcome Citation is Welcome Cooperation organization International Council of Ophthalmology(ICO), PubMed, PMC, American Academy of Ophthalmology, Asia-Pacific, Thomson Reuters, The Charlesworth Group, Crossref,Scopus,Publons, DOAJ etc.

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