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

You, In Cheon; Yoon, Kyung-Chul

doi:10.1097/ico.0b013e31823f8f15

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…The optimal route of administration of corticosteroid remains unknown and many different approaches, such as systemic, topical, subconjunctival, and intraocular, have been proposed and used with variable rate of success. 3 – 6 To our knowledge, this is the first report describing multimodal imaging of long-lasting corneal endothelial graft rejection successfully reversed 3 months after dexamethasone intravitreal implant.…”

Section: Introductionmentioning

confidence: 84%

Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant

Giannaccare¹,

Fresina²,

Pazzaglia³

et al. 2016

IMCRJ

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Graft rejection is the most significant complication corneal transplantation and the leading indication for overall corneal transplantation. Corticosteroid therapy represents the mainstay of graft rejection treatment; however, the optimal route of administration of corticosteroid remains uncertain. We report herein for the first time the multimodal imaging of a case of long-lasting corneal endothelial graft rejection successfully reversed 3 months after dexamethasone intravitreal implant. A 29-year-old Asian female presented with a long-lasting corneal endothelial graft rejection in her left phakic eye. She underwent penetrating keratoplasty for advanced keratoconus 24 months before presentation. Hourly dexamethasone eyedrops, daily intravenous methylprednisolone, and one parabulbar injection of methylprednisolone acetate were administered during the 5 days of hospitalization. However, the clinical picture remained approximately unchanged despite therapy. By mutual agreement, we opted for the off-label injection of dexamethasone 0.7 mg intravitreal implant in order to provide therapeutic concentrations of steroid for a period of ~6 months. No other concomitant therapies were prescribed to the patient. Visual acuity measurement, slit lamp biomicroscopy, anterior segment photography, confocal microscopy, anterior segment optical coherence tomography, laser cell flare meter, intraocular pressure measurement, and ophthalmoscopy were performed monthly for the first postoperative 6 months. Three months after injection, both clinical and subclinical signs of rejection disappeared with a full recovery of visual acuity to 20/30 as before the episode. Currently, at the 12-month follow-up visit, the clinical picture remains stable without any sign of rejection, recurrence, or graft failure. Dexamethasone intravitreal implant seems to be a new potential effective treatment for corneal graft rejection, particularly in case of poor compliance or lack of response to conventional treatment. In addition, it could be especially useful in diabetic patients unable to receive systemic steroids.

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Section: Introductionmentioning

confidence: 84%

Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant

Giannaccare¹,

Fresina²,

Pazzaglia³

et al. 2016

IMCRJ

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“…[ 38 ] suggested the intracameral application of corticosteroids by means of an AC flush as an adjunctive measure. You et al ,[ 39 ] investigated the efficacy of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of endothelial graft rejection. Intravitreal dexamethasone implant can be used in refractory cases of CGR, however, no randomized controlled trial (RCT) has been performed to assess the efficacy of this therapy.…”

Section: Managementmentioning

confidence: 99%

Management and prevention of corneal graft rejection

Mandal,

Maharana,

Kaweri

et al. 2023

Indian Journal of Ophthalmology

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The management of an episode of corneal graft rejection (CGR) is primarily by corticosteroids. Immunomodulators are useful for long-term immunosuppression and in dealing with cases of high-risk (HR) corneal grafts. The classical signs of CGR following penetrating keratoplasty (PKP) include rejection line, anterior chamber (AC) reaction, and graft edema. However, these signs may be absent or subtle in cases of endothelial keratoplasty (EK). Prevention of an episode of graft rejection is of utmost importance as it can reduce the need for donor cornea significantly. In our previous article (IJO_2866_22), we had discussed about the immunopathogenesis of CGR. In this review article, we aim to discuss the various clinical aspects and management of CGR.

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Prevention and Treatment of Transplant Rejection in Keratoplasty

Pleyer

Maier

2014

Immune Modulation and Anti-Inflammatory Therapy in Ocular Disorders

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

Abstract: IVTA injection was effective in reducing the time to improvement of endothelial graft rejection. Increased expression of CXCL-9, -10, and -11, and their receptors in the aqueous humor of patients with endothelial graft rejection decreased after treatment.

Cited by 5 publications

References 23 publications

Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant

Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant

Management and prevention of corneal graft rejection

Prevention and Treatment of Transplant Rejection in Keratoplasty

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