Case–control study of subconjunctival triamcinolone acetonide injection vs intravenous methylprednisolone pulse in the treatment of endothelial corneal allograft rejection

Abstract

Purpose To assess the safety and effectiveness of treating corneal endothelial rejection with a subconjunctival injection of 20 mg triamcinolone acetonide in combination with topical application of 1% prednisolone acetate, as compared to treatment with an intravenous pulse of 500 mg methylprednisolone in combination with topical application of 1% prednisolone acetate. Methods A case-controlled study including a literature review was performed. Patients who presented with an initial episode of corneal endothelial rejection were treated with subconjunctival injection of 20 mg triamcinolone in combination with topically applied 1% prednisolone and were retrospectively matched for age and diagnosis to patients who received a single intravenous injection of 500 mg methylprednisolone in combination with topical 1% prednisolone. Patients were analysed regarding reversion of the rejection episode, intraocular pressure, and visual acuity after 1 year.

Multiquadrant Subtenon Triamcinolone Injection for Acute Corneal Graft Rejection: A Case Report

“…Intravenous pulse methylprednisolone (500–1,000 mg for 3 days) has been thought to reset the immune system and may be associated with superior graft survival when administered within the first week of the rejection episode [9]. Subconjunctival or posterior subtenon triamcinolone injections, along with topical steroids, have been considered valid alternatives in the treatment of endothelial rejection [10]. In this case, after no improvement in the signs of graft rejection was noted with intravenous pulse methylprednisolone treatment, in addition to an hourly topical steroid, a subtenon triamcinolone injection in the superotemporal quadrant produced significant clearing in the superior half of the cornea on follow-up 1 week later.…”

Therapeutic Effect of Intravitreal Injection of Triamcinolone in the Treatment of Endothelial Graft Rejection

“…The 5-year corneal failure rate after penetrating keratoplasty is roughly 25% to 35%. 1,5 The rate of reversibility after an acute corneal graft rejection is quite variable, ranging from 50% to 94%. 1,6,7 Corticosteroid therapy is the mainstay of treatment for corneal graft rejection.…”

“…1,5 The rate of reversibility after an acute corneal graft rejection is quite variable, ranging from 50% to 94%. 1,6,7 Corticosteroid therapy is the mainstay of treatment for corneal graft rejection. The optimal route of administration of corticosteroid remains unknown, but many diverse approaches, such as systemic, topical, subconjunctival, and intraocular steroids, have been used.…”

“…[1][2][3][4] It is a complex immune-mediated process, resulting in decompensation of the transplanted cornea, and is a main cause of graft failure. An endothelial immune reaction is the most severe form of rejection because destruction of the graft endothelium can lead to graft failure.…”

“…The optimal route of administration of corticosteroid remains unknown, but many diverse approaches, such as systemic, topical, subconjunctival, and intraocular steroids, have been used. [1][2][3][4]8 The intracameral application of corticosteroids is known to be an adjunctive method that can treat moderate-to-severe endothelial immune reactions. 3,4 The most commonly used drug for this purpose is triamcinolone.…”