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Bali S, Filek R, Si F, et al. Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review. J Clin Med Res. 2016;8(4):269-76doi: 10.14740/jocmr2326w.
Bali, S., Filek, R., Si, F., & Hodge, W. (2016). Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review. Journal of clinical medicine research, 8(4), 269-76. https://doi.org/10.14740/jocmr2326w
Bali, Shveta, et al. "Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review." Journal of clinical medicine research vol. 8,4 (2016): 269-76. doi: https://doi.org/10.14740/jocmr2326w
Bali S, Filek R, Si F, Hodge W. Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review. J Clin Med Res. 2016 Apr;8(4):269-76. doi: 10.14740/jocmr2326w. Epub 2016 Feb 27. PMID: 26985246; PMCID: PMC4780489.
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J Clin Med Res. 2016 Apr;8(4):269-76. doi: 10.14740/jocmr2326w. Epub 2016 Feb 27.

Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review.

Journal of clinical medicine research

Shveta Bali, Richard Filek, Francie Si, William Hodge

Affiliations

  1. Department of Ophthalmology, Western University, London, Ont. N6A 4V2, Canada.
  2. Department of Ophthalmology, Western University, London, Ont. N6A 4V2, Canada; Department of Pathology, Western University, London, Ont. N6A 4V2, Canada.
  3. Department of Ophthalmology, Western University, London, Ont. N6A 4V2, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ont. N6A 4V2, Canada.

PMID: 26985246 PMCID: PMC4780489 DOI: 10.14740/jocmr2326w

Abstract

Cornea transplantation has a high success rate and typically only requires topical immunomodulation. However, in high-risk cases, systemic immunosuppression can be used. We conducted a systematic review on the efficacy and side effects of systemic immunosuppression for high-risk cornea transplantation. The study population was 18 years old or older with a high-risk transplant (two or more clock hours of cornea vascularization or a previous failed graft or a graft needed because of herpes simplex keratitis). A comprehensive search strategy was performed with the help of an information specialist and content experts from ophthalmology. All study designs were accepted for assessment. Level 1 and level 2 screening was performed by two reviewers followed by data abstraction. Forest plots were created whenever possible to synthesize treatment effects. Quality assessment was done with a Downs and Blacks score. From 1,150 articles, 29 were ultimately used for data abstraction. The odds ratios (ORs) for clear graft survival in cyclosporine and controls were 2.43 (95% CI: 1.00 - 5.88) and 3.64 (95% CI: 1.48 - 8.91) for rejection free episodes. Mycophenolate mofetil (MMF) significantly improved the rejection free graft survival rates at 1 year (OR: 4.05, 95% CI: 1.83 - 8.96). The overall results suggested that both systemic cyclosporine and MMF improved 1-year rejection free graft survival in high-risk keratoplasty. Cyclosporine also significantly improved clear graft survival rates at 1 year; however, there were insufficient data to analyze the same in the MMF group. Higher quality studies are needed to understand this issue better.

Keywords: Cyclosporine; High risk; Immunosuppression; Keratoplasty; Mycophenolate mofetil; Systematic review

References

  1. Int Ophthalmol. 2008 Jun;28(3):209-22 - PubMed
  2. Ophthalmology. 1987 Aug;94(8):935-44 - PubMed
  3. Ophthalmology. 1994 Jan;101(1):120-7 - PubMed
  4. Arch Ophthalmol. 1992 Oct;110(10):1392-403 - PubMed
  5. J Epidemiol Community Health. 1998 Jun;52(6):377-84 - PubMed
  6. Jpn J Ophthalmol. 2001 Jul-Aug;45(4):378-82 - PubMed
  7. Graefes Arch Clin Exp Ophthalmol. 1996 Aug;234 Suppl 1:S115-21 - PubMed
  8. Ophthalmology. 2001 Oct;108(10):1838-44 - PubMed
  9. Cornea. 2011 Dec;30(12 ):1398-405 - PubMed
  10. Cornea. 1995 Nov;14(6):610-3 - PubMed
  11. Ophthalmology. 2001 Mar;108(3):461-9 - PubMed
  12. Br J Ophthalmol. 2007 Jan;91(1):51-5 - PubMed
  13. Ophthalmologe. 1997 Jul;94(7):496-500 - PubMed
  14. Ophthalmology. 1994 Jan;101(1):128-33 - PubMed
  15. Health Technol Assess. 2003;7(41):1-90 - PubMed
  16. Br J Ophthalmol. 2002 Sep;86(9):945 - PubMed
  17. Cornea. 2003 Aug;22(6):552-6 - PubMed
  18. BMC Public Health. 2012 Nov 08;12:955 - PubMed
  19. Transplantation. 1988 Mar;45(3):651-3 - PubMed
  20. Ophthalmology. 2003 Jul;110(7):1396-402 - PubMed
  21. Transpl Int. 2005 Jun;18(6):703-8 - PubMed
  22. Am J Ophthalmol. 2011 Jul;152(1):33-39.e1 - PubMed
  23. Am J Ophthalmol. 1989 May 15;107(5):506-10 - PubMed
  24. Invest Ophthalmol Vis Sci. 2001 May;42(6):1293-8 - PubMed
  25. Transplantation. 2006 Mar 15;81(5):767-72 - PubMed
  26. Br J Ophthalmol. 2001 Dec;85(12):1464-9 - PubMed
  27. Am J Ophthalmol. 2005 Dec;140(6):1112-22 - PubMed
  28. Graefes Arch Clin Exp Ophthalmol. 2001 Jun;239(5):367-72 - PubMed
  29. Eye (Lond). 2009 Nov;23 (11):2063-70 - PubMed
  30. Ocul Immunol Inflamm. 1996;4(1):15-24 - PubMed
  31. Ger J Ophthalmol. 1992;1(6):432-6 - PubMed
  32. Indian J Ophthalmol. 2012 Jan-Feb;60(1):15-21 - PubMed
  33. Ocul Immunol Inflamm. 2010 Jun;18(3):162-71 - PubMed
  34. Br J Ophthalmol. 2002 Sep;86(9):988-92 - PubMed
  35. Am J Ophthalmol. 2010 Aug;150(2):179-84 - PubMed
  36. Doc Ophthalmol. 1986 May 15;62(4):337-44 - PubMed
  37. Transplantation. 2005 Apr 27;79(8):964-8 - PubMed
  38. Ophthalmology. 2008 Jun;115(6):975-982.e1 - PubMed
  39. Br J Ophthalmol. 1999 Nov;83(11):1268-71 - PubMed
  40. Jpn J Ophthalmol. 1997 Jul-Aug;41(4):209-16 - PubMed
  41. Graefes Arch Clin Exp Ophthalmol. 2003 Dec;241(12 ):1051-4 - PubMed

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