A COMPARATIVE STUDY OF EFFICACY OF PREDNISOLONE ACETATE (1%) EYE DROPS ALONE AND WITH CYCLOSPORINE (0.05%) EYE DROPS IN OPTICAL PENETRATING KERATOPLASTY

Neebha Anand*, J. P. Chugh, Jyoti Deswal, Sunil Verma and Rakesh Verma

ABSTRACT

Introduction - Keratoplasty or corneal transplantation is one of the most common and successful tissue transplantations worldwide. Corticosteroids, cyclosporine, and cytotoxic agents are all important therapeutic agents that can be used to treat inflammation and play role in prevention and treatment of graft rejection. Objective - To compare the efficacy of prednisolone acetate (1%) eye drops alone and with cyclosporine (0.05%) eye drops in optical penetrating keratoplasty. Material and Methods-30 patients undergoing optical penetrating keratoplasty in a tertiary health care hospital in north India were randomly divided into two groups. Patients in group 1 were put on prednisolone acetate 1% eye drops post – operatively for 24 weeks. Patients in group 2 were put on prednisolone acetate 1% and 0.05% cyclosporine eye drops for 24 weeks. Follow-up of the patients was done every 2 weeks for 16 weeks, and every month for next 2 months. At each visit, clinical evaluation of the transplanted graft was made and scoring was done for corneal transparency, corneal edema and neovascularisation of graft. Results- At the end of study, 4 patients (26.67%) in group 1 had diffuse marked stromal edema while only 1 patient (6.67%) in group 2 had diffuse marked stromal edema. Maximum number of patients (40%) in group 1 had new vessels invading the graft while in group 2, maximum number of the patients (53.33%) had new vessels invading less than 1/3 recipient bed. 8 patients (53.33%) in group 1 and 10 patients (66.67%) in group 2 had clear cornea. Five patients (33.33%) had white cornea in group 1 while 2 patients (13.33%) had white cornea in group 2. Graft rejection rate was calculated taking into account graft transparency. Graft transparency ≥3 was considered as rejection. At the end of 6 months, 6 patients (40%) in group 1 showed rejection as compared to three patients (20%) in group 2. Overall rejection rate after 6 months was 30%. However, difference in rejection rates between two groups is not statistically significant (p- valve > 0.05). Conclusion- Topical 2% cyclosporine A is an effective adjunct to topical steroids in preventing acute corneal graft rejection episodes or increasing rejection free time interval. But a large multi-centric trial should be carried out to support the evidence.

Keywords: Keratoplasty, prednisolone, cyclosporine, graft rejection.