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Authors have no financial interest. The effectiveness of 0.05% topical cyclosporine A to graft rejection in various corneal transplantations Jae-Woong Koh (MD/PhD)1, Jung-Hyun Park (MD)1 Gil-Joong Yoon (MD/PhD) 2 Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Republic of Korea 1 Happy Eye Clinic, Gwangju, Republic of Korea 2 Authors have no financial interest.

Dr. Koh Dr. Park Dr. Yoon

Purpose To evaluate the effectiveness of 0.05% topical cyclosporine A to graft rejection in various corneal transplantations.

Methods Nonrandomized prospective study The 39 patients (39 eyes) who underwent keratoplasty in Chosun University Hospital from March 2005 until March 2007 Group A : 1% prednisolone acetate* + 0.05% cyclosporin A* (18 eyes) Group B : 1% prednisolone acetate* + 0.05% cyclosporin A** (10 eyes) Group C : topical 1% prednisolone acetate only* (11 eye) ( * : start immediately after operation/ ** : start 6months after operation)

Treatment regimen PK = Penetrating Keratoplasty CsA : Cyclosporine A Regimens (Months after post operation) A B C Start of topical CsA Immediately 6 No Oral predisolone discontinued 3 Topical predisolone tapering start Topical predisolone discontinued 12 PK = Penetrating Keratoplasty CsA : Cyclosporine A ( * : start immediately after operation/ ** : start 6months after operation)

Patient`s distribution and failure rate Group A Group B Group C Subject (n) 18 10 11 Male: Female (n) 11: 7 8: 2 11: 0 Age (yrs) mean 54.03 48.11 44.27 Rejection episode n (%) 2 (11) 1 (10) 5 (45)

Preopearative diagnosis of the patient Preoperation Diagnosis Group A Group B Group C Keratoconus, n (%) 1 (5) 0 (0) 1 (9) Corneal dystrophy, n (%) 1 (10) Bullous keratopathy, n (%) 2 (11) 3 (30) 5 (45) Corneal opacity*, n (%) 4 (22) 2 (18) Corneal perforation, n (%) 3 (16) Corneal ulcer, n (%) 8 (44) * Corneal opacity of unknown etiology

Result Compared to Group C, Group A and B, which used both topical steroid and cyclosporine A, have occurred lower corneal transplants rejection (P=0.033). Application of time for Cyclosporin A 0.05% had no effectiveness on rejection of corneal transplants.( P=0.172) The period of rejection for transplants in group C was observed occuring earlier than the other 2 groups, there is no significance in statistics. (P=0.149)

Result

Conclusions Combination treatment of 1% prednisolone acetate and 0.05% cyclosporin A is effective for the inhibition of graft rejecitions in various corneal transplantations.