Bertelmann E, Torun N, Pleyer U
Augenklinik, Charité Campus Virchow Klinikum, Universitätsmedizin, Augustenburger Platz 1, Berlin.
Klin Monbl Augenheilkd. 2013 May;230(5):505-11. doi: 10.1055/s-0032-1328549. Epub 2013 May 21.
Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.
如今，对于高危穿透性角膜移植术后的免疫抑制治疗，霉酚酸酯（MMF）可被视为除环孢素A之外的标准治疗方法。包括多中心研究在内的多项临床研究已证实全身性MMF用于该适应症的疗效。目前正在讨论霉酚酸（MPA）疗法是否具有更多优势。西罗莫司和他克莫司虽有效果，但由于副作用发生率较高而未取得临床重要地位。联合治疗的额外益处尚未得到目前临床研究的证实。依维莫司在临床前显示出有前景的免疫抑制和抗增殖作用。局部使用免疫抑制剂作为单一疗法显然不足以替代全身性免疫抑制治疗。局部联合治疗能否成为全身性治疗的替代方法，有待在未来几年得到证实。
