Clinical Study
Eye (2009) 23, 635–639; doi:10.1038/eye.2008.25; published online 22 February 2008
Intravenous dexamethasone vs methylprednisolone pulse therapy in the treatment of acute endothelial graft rejection
This article was presented in part as a poster at the World Cornea Congress, Washington DC, USA in March 2005.
R Tandon1, K Verma1, B Chawla1, N Sharma1, J S Titiyal1, M Kalaivani2 and R B Vajpayee1,3
- 1Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
- 2Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
- 3Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
Correspondence: R Tandon, Professor of Ophthalmology, Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110029, India. Tel: +91 11 2659 3145; Fax: +91 11 2658 8626; E-mail: radhika_tan@yahoo.com
Received 17 September 2007; Accepted 21 January 2008; Published online 22 February 2008.
Abstract
Purpose
To study the outcome of therapy for acute endothelial graft rejection with an intravenous (i.v.) pulse of dexamethasone vs methylprednisolone, in addition to topical corticosteroids.
Methods
Records of 98 eyes of 99 patients treated for endothelial graft rejection with a single i.v. pulse of dexamethasone or methylprednisolone in addition to topical steroids, between January 1999 and June 2004, were retrospectively reviewed. Baseline characteristics such as surgery-rejection interval, time taken to consult after onset of symptoms, history of failed grafts, extent of stromal vascularization, best-corrected visual acuity (BCVA) and corneal thickness at the time of presentation were noted. Main outcome measures following treatment for rejection included improvement in BCVA, change in corneal thickness, and reversal of graft rejection.
Results
Fifty-one patients were treated with i.v. methylprednisolone and 47 with i.v. dexamethasone, in addition to topical steroids. Both groups were found to be comparable with respect to baseline parameters, that is, time taken to present, history of failed grafts, extent of stromal vascularization, BCVA, and graft thickness. Graft rejection could be successfully reversed in 72.3% cases in the dexamethasone group and 49% in the methylprednisolone group (P=0.018). A significant improvement in visual acuity was recorded following treatment in both groups, with a better outcome in the dexamethasone group (P=0.012). Post-treatment pachymetry values were lower than pretreatment values in both groups, with significantly lower final pachymetry in the dexamethasone group (P=0.017). No adverse effects were observed.
Conclusion
I.v. pulse therapy with dexamethasone may be used as an effective alternative to methylprednisolone in reversing acute endothelial graft rejection.
Keywords:
endothelial graft rejection, intravenous pulse therapy, methylprednisolone, dexamethasone, topical steroids
