Observation Of Tacrolimus Eye Drops On High-risk Penetrating Keratoplasty Patients

Objective: To evaluate the clinical efficacy of topical tacrolimus 0.1% and cyclosporin 1% on high-risk penetrating keratoplasty(PKP)patients.And to provide reference for the clinical application of tacrolimus eye drops and the treatment of high-risk penetrating keratoplasty patients.Methods:A series of 49 high-risk PKP patients(49 eyes)from the year of 2012 to 2017 were recruited in this study.The patients were divided into two groups by receiving either topical tacrolimus 0.1% or cyclosporin 1%.25 patients were treated with topical tacrolimus 0.1% and 24 patients with topical cyclosporin 1%.High-risk scores were performed in two groups.The traditional baseline management on these two groups were Tobramycin and Dexamethasone Eye Drops in the first three weeks and then tapered off in addition to fungal keratitis.Clinical procedures and post-operative follow-up were documented.Results: After 6 to 54 months follow-up,with the average of 24 months.The risk scorings in tacrolimus and cyclosporin group were no clinical statistic significant difference.15 of 49 high-risk patients(15eyes)had graft rejection,the rejection rate was 30.61%.On tacrolimus group,the rejection occurred in four patients(4 eyes)with rejection rate of 16%,and no irreversible rejection was observed.The rejection occurred from 35 days to 20 months after PKP.11 of 24 patients(11 eyes)had graft rejection,the rejection rate was 45.8% in cyclosporin group.The rejection occurred from 23 days to 24 months after PKP.Three patients had irreversible rejection.21 patients(91.3%)had increased visual acuity and 19 patients(76%)had kept the graft transparency in tacrolimus group.14 patients(63.64%)had enhanced visual acuity and 11 patients(45.8%)had kept the graft transparency in cyclosporin group.There were clinical statistic significant difference(p < 0.05).Conclusions:As compared with the topical cyclosporin 1%,topical tacrolimus 0.1%,a key immunosuppressant,significantly decreased corneal graft rejection rate,enhanced best corrected visual acuity and kept the graft transparency.