Study Of The Immunosuppressive Activity Of The Tacrolimus Eye Drops In High-risk Corneal Transplantation

Objective: To observe Tacrolimus(FK506)eye drops to prevent the effect of immune rejection after high-risk corneal transplantation,and we analyzed the factors that were still ineffective after corneal transplantation.Methods: Retrospective study,Forty-eight patients(50 eyes)selected from Shandong Eye Hospital from 2013 to 2015 who underwent corneal transplantation with high risk of rejection were divided into tacrolimus eye drops group 23 case(25 eyes)and cyclosporine25 case(25 eyes),all patients were treated with combination of glucocorticoid.There was no significant difference between the tacrolimus group and the cyclosporine group(t =0.65,p = 0.52> 0.05).We used the Rejection index(RI)score to determine whether the immunological rejection of the graft occurred,and when RI?5,the immunological rejection was considered to occur.Patients were followed up for 1 year and observed the incidence and time-of-development curves of the two groups of patients after corneal transplantation,and we analyzed the risk factors for immune rejection after the patient was treated with tacrolimus after corneal transplantation.Results: 1.The incidence of immunological rejection in 1 year was 10%(10 eyes)in the cyclosporine group,the incidence of immunological rejection was 40.00%,and 3 cases(3eyes)in the tacrolimus group were excluded,the incidence of immunological rejection was 12.00 %,Tacrolimus group was significantly lower than the cyclosporine group,the difference was significant(X~2 = 5.09,p <0.05).2.The incidence of rejection in the tacrolimus group and cyclosporine group was 4%(1eye)within 2 months after surgery,and the incidence of rejection was no difference.The incidence of immunoreactivity in the tacrolimus group was 8%(2 eyes)and 36%(9 eyes)in the cyclosporine group at 2 months to 12 months after corneal transplantation,and the immunological rejection in the tacrolimus group The rate was significantly lower than the cyclosporine group.3.There were still three cases of rejection in patients with tacrolimus eye drops after surgery: 2 eyes were treated with multiple corneal transplants and a large number of neovascularizations were found in the entire week of the implant bed,with 1 eye experienced 5 times of corneal transplantation surgery,1 month after the exclusion of 1eye experience 4 times of corneal transplantation surgery,after 10 months of rejection;1eye for surgery after March irregular application of tacrolimus eye drops,postoperative10 Month exclusion.Conclusion: 1.High-risk corneal transplantation after the application of tacrolimus eye drops can effectively prevent the occurrence of immune rejection.2.High-risk corneal transplantation patients were treated with tacrolimus eye drops and the application of cyclosporine eye drops,within 2 months to prevent the effect of rejection was not significant,the use of tacrolimus eye drops to prevent rejection was significantly better than cyclosporine Eye drops after 2 months.3.Patients with high-risk corneal transplantation after tacrolimus eye drops can not completely avoid rejection.After some times of corneal transplantation,a large number of newborn blood vessels in the whole week,postoperative irregular medication for the application of tacrolimus eye drops are still the risk of rejection factors.