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目的 探讨长期应用环孢素A(CyclosporinA ,CsA)联合地塞米松滴眼液对高危穿透性角膜移植术后免疫排斥反应的防治效果及其安全性。方法 4 2例 (42眼 )高危穿透性角膜移植术后患者 ,术后 3个月随机分为二组 :Ⅰ组为实验组 2 3例 2 3眼 ,应用 1%CsA和 0 .1%地塞米松溶液滴眼 ,每日各 2～ 3次 ,交替用药 ,术后 6个月后地塞米松浓度改为 0 .0 5 % ,每日各 2次 ,交替用药 ,直至术后 1年 ;Ⅱ组为对照组 19例 19眼在术后 3月改为单纯 1%CsA滴眼 ,每日 3次 ,直至术后 1年。所有病例随访观察 1年以上。结果 4 2眼PKP术后发生角膜植片免疫排斥反应 11眼 (2 6 .19% ) ,其中I组 4眼 (17.39% ) ,Ⅱ组 7眼 (36 .84 % ) ,差异具有显著性(P <0 .0 5 )。其它并发症的发生率两组间无显著性差异。术后患者视力均较术前明显提高 ,差异具有显著性(P <0 .0 5 )。结论 较长期应用 1%CsA联合地塞米松滴眼 ,可以安全、有效地降低高危PKP术后植片免疫排斥反应发生率 ,从而提高穿透性角膜移植的成功率。
Objective To investigate the long-term use of cyclosporin A (CsA) combined with dexamethasone eye drops on the prevention and treatment of high-risk penetrating keratoplasty after immunological rejection and its safety. Methods Forty-two patients (42 eyes) with high-risk penetrating keratoplasty were randomly divided into two groups after operation: Group Ⅰ was 23 cases and 23 eyes in experimental group, with 1% CsA and 0.1% Dexamethasone solution drops, 2 to 3 times a day, alternating medication, 6 months after dexamethasone concentration was changed to 0.05%, 2 times a day, alternating medication, until 1 year after surgery . In group Ⅱ, 19 cases of 19 cases in control group were changed to simple 1% CsA eye drops 3 months after operation until 1 year after operation. All cases were followed up for more than 1 year. Results There were 11 eyes (22.6%) with keratoplasty rejection after PKP in 4 of 2 eyes, of which 4 eyes (17.39%) in group I and 7 eyes (36.84%) in group Ⅱ showed significant difference P <0. 05). The incidence of other complications no significant difference between the two groups. Visual acuity in postoperative patients was significantly higher than that before operation, the difference was significant (P <0.05). Conclusion Long-term use of 1% CsA combined with dexamethasone eye drops can safely and effectively reduce the incidence of immunological rejection after high-risk PKP surgery, thereby improving the success rate of penetrating keratoplasty.