Zhang Jin-Yu, Yu Kang, Jiang Xiu-Ying, Liang Jia-Xin, Zhou Shi-You
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China.
Department of Ophthalmology, the Second People's Hospital of Foshan, Foshan 528099, Guangdong Province, China.
Int J Ophthalmol. 2024 Dec 18;17(12):2229-2235. doi: 10.18240/ijo.2024.12.10. eCollection 2024.
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).
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.
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 (<0.01, log-rank test). The clear graft survival rate was 83.6% in Group 1 and 36.7% in Group 2 (<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.
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.
探讨全身应用霉酚酸酯（MMF）联合局部应用他克莫司（FK506）及糖皮质激素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。
在这项队列研究中，纳入了来自一个眼科中心的55例连续患者（55只眼），这些患者符合HRK标准。HRK的定义包括直径不少于9mm的大植片、两个或更多象限的角膜血管化、再次移植或偏心植片。穿透性角膜移植术后，2019年10月起，25例接受全身MMF联合0.05% FK506及逐渐减量的糖皮质激素滴眼液治疗的患者被纳入第1组。2018年1月至2019年9月，30例仅接受术后0.05% FK506及逐渐减量的糖皮质激素滴眼液治疗的患者被纳入第2组。所有参与者术后均接受密切监测，并在一年的随访期内收集和评估移植排斥反应事件及相关临床数据。
随访9.6±3.2个月后，第1组有4例（16%）发生移植排斥反应，第2组有18例（60%）发生移植排斥反应。第1组发生1例可逆性和3例不可逆性移植排斥反应，第2组发生3例可逆性和15例不可逆性移植排斥反应。Kaplan-Meier分析显示，第1组82.5%的植片和第2组37.1%的植片未发生角膜移植排斥反应（<0.01，对数秩检验）。随访一年内，第1组的植片清晰存活率为83.6%，第2组为36.7%（<0.01，对数秩检验）。随访期间两组均未观察到严重的全身副作用。
MMF、局部FK506及糖皮质激素滴眼液组成的三联治疗方案是有效预防HRK患者移植排斥反应和提高植片存活率的一种有前景的策略。
