Corneal Graft Rejection Medication

  • Author: Jason Jacobs, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 17, 2010
 

Medication Summary

Corticosteroids are the mainstay of treatment of acute graft rejection. They can be given topically, via subconjunctival injection, or systemically.

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Corticosteroids

Class Summary

These agents provide anti-inflammatory activity to suppress the natural immune response that leads to acute graft rejection.

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Prednisolone acetate 1% (AK-Pred, Pred Forte)

 

Most commonly used topical corticosteroid. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Dexamethasone (Decadron, Dexasone)

 

For various allergic and inflammatory diseases. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Also used for subconjunctival injections.

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Prednisone (Deltasone)

 

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Methylprednisolone (Solu-Medrol, Depo-Medrol)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Single pulsed dose of IV steroids prior to PO steroids may improve final outcome.

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Contributor Information and Disclosures
Author

Jason Jacobs, MD  Clinical Faculty, Department of Ophthalmology, University of Colorado Health Sciences Center

Jason Jacobs, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, International Society of Refractive Surgery, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Taravella, MD  Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Professor, Department of Ophthalmology, University of Colorado School of Medicine

Michael Taravella, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America

Disclosure: Alcon Honoraria Speaking and teaching; Allergan Honoraria Speaking and teaching; Surgical Specialties Honoraria Speaking and teaching; BD Surgical Supplies Honoraria Speaking and teaching

Specialty Editor Board

Jack L Wilson, PhD  Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis

Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  8. Hill JC. The use of cyclosporine in high-risk keratoplasty. Am J Ophthalmol. May 15 1989;107(5):506-10. [Medline].

  9. Hill JC, Maske R, Watson P. Corticosteroids in corneal graft rejection. Oral versus single pulse therapy. Ophthalmology. Mar 1991;98(3):329-33. [Medline].

  10. Hwang DG, Stern WH, Hwang PH, MacGowan-Smith LA. Collagen shield enhancement of topical dexamethasone penetration. Arch Ophthalmol. Sep 1989;107(9):1375-80. [Medline].

  11. Khodadoust AA, Silverstein AM. Transplantation and rejection of individual layers of the cornea. In: Investigative Ophthalmologic and Visual Sciences. Vol 8. 180-195.

  12. Reidy JJ, Gebhardt BM, Kaufman HE. The collagen shield. A new vehicle for delivery of cyclosporin A to the eye. Cornea. Jul 1990;9(3):196-9. [Medline].

  13. Smolin G, Thoft RA. The cornea. In: Scientific Foundations and Clinical Practice. 3rd ed. Lippincott William & Wilkins; 1994.

  14. Wang M, Lin Y, Chen J, Liu Y, Xie H, Ye C. Studies on the effects of the immunosuppressant FK-506 on the high-risk corneal graft rejection. Yan Ke Xue Bao. Sep 2002;18(3):160-4. [Medline].

  15. Wilson SE, Kaufman HE. Graft failure after penetrating keratoplasty. Surv Ophthalmol. Mar-Apr 1990;34(5):325-56. [Medline].

 
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This severely vascularized cornea would be at high risk for graft rejection following a penetrating keratoplasty. This patient experienced Stevens-Johnson syndrome.
This is an example of an acute graft rejection episode. Note the graft edema, Descemet folds, and keratic precipitates.
 
 
 
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