Systematic review of penetrating keratoplasty rejection treated by immunosuppressants

Abstract

To investigate the validity and side-effect of immunosuppressants for preventing and treating of immune rejection after penetrating keratoplasty (PKP). Randomized and non-randomized controlled trials of immunosuppressants after PKP were searched from Pubmed, EMbase.com, Cochrane library, CNKI and Wanfang database; methodological quality and meta-analysis were carried out according to Evidence-Based Medicine(EBM). Thirty-one studies in all were evaluated, of which twenty-three were about the prevention, and nine were about the treatment after PKP. The rate of immune rejection after normal PKP is 4.9%-28.9% when using corticosteroids to prevent immune rejection, especially for long-time use. According to meta-analysis: the effectiveness of local cyclosporine A and local FK-506 in preventing immune rejection after PKP is significant, and FK-506 is more effective than CsA topically; systemic CsA and MMF could effectively prevent immune rejection after high-risk PKP; as far as treating immune rejection, corticosteroid, whether topical or systemic, was effective; however additional topical CsA could not improve the treatment effect. The use of immunosuppressants such as corticosteroids and CsA whether topical or systemic can effectively prevent the occurrence of immune rejection after high-risk PKP.