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Outcomes following tacrolimus systemic immunosuppression for penetrating keratoplasty in infants and young children
- Source :
- Eye. 36:2286-2293
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- OBJECTIVE To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children. METHODS Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children's hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus. RESULTS Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED). One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28-84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR. CONCLUSION We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.
- Subjects :
- Graft Rejection
medicine.medical_specialty
genetic structures
medicine.medical_treatment
Perforation (oil well)
Glaucoma
Tacrolimus
Cohort Studies
Dysgenesis
medicine
Humans
Child
Retrospective Studies
Immunosuppression Therapy
business.industry
Graft Survival
Infant, Newborn
Infant
Immunosuppression
medicine.disease
Surgery
Ophthalmology
Child, Preschool
Cohort
Congenital hereditary endothelial dystrophy
business
Keratoplasty, Penetrating
Follow-Up Studies
Cohort study
Subjects
Details
- ISSN :
- 14765454 and 0950222X
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- Eye
- Accession number :
- edsair.doi.dedup.....b50831b8a3f944021199fc057ba963a1