他克莫司滴眼液预防高危角膜移植术后排斥反应的效果观察

Observation on the efficacy of Tacrolimus eye drops for preventing rejection after high-risk corneal transplantation

目的观察他克莫司（Tacmlimus）滴眼液预防环孢素滴眼液疗效欠佳的高危角膜移植术后排斥反应的效果。方法回顾性研究2008年4月至2015年5月多次实施穿透性角膜移植术9例（10只眼）的临床资料。首次术后使用环孢素滴眼液预防免疫排斥，再次穿透性角膜移植术后，5只眼使用他克莫司滴眼液；另5只眼使用环孢素滴眼液，排斥发生后改用他克莫司滴眼液。结果lO只眼首次移植术后使用环孢素滴眼液随访（41．70±8．53）个月，其中9只眼（90．00％）出现排斥。最终10只眼均因植片浑浊再次行穿透性角膜移植术，术后5只眼应用他克莫司滴眼液，随访（16．00±2．68）个月，2只眼（40．00％）出现排斥；另5只眼术后应用环孢素滴眼液随访（36．20±7．95）个月，5只眼（100．00％）出现排斥，改为他克莫司滴眼液，经抗排斥治疗植片透明，随访（13．40±3．17）个月，1只眼（20．00％）出现排斥。结论高危角膜移植术后，使用环孢素滴眼液预防排斥效果欠佳时改用他克莫司滴眼液，多数患者能获得较好的效果。

Objective To observe the efficacy of Tacrolimus eye drops for preventing rejection after treatment of high-risk penetrating keratoplasty in patients with poor response. Cyclosporin A eye drops. Methods The data of 10 eyes of 9 patients with high-risk penetrating keratoplasty from Apr. 2008 to Jun. 2015 were analyzed retrospectively. Cyclosporine A eye drops were applied after the first penetrating keratoplasty. Five eyes were treated with Tacrolimus eye drops after secondary penetrating keratoplasty, and the other 5 eyes were treated with Cyclosporine A eye drops. Results Ten eyes were followed up for （41.70 ± 8.53 ） months after corneal transplantating, rejection happened in 9 eyes （90.00%） . All eyes underwent penetrating keratoplasty due to grafts opacification. Five eyes were treated with Tacrolimus eye drops and followed up for （ 16.00 ±2.68） months. The rejection occurred in 2 eyes（40.00% ）. The other 5 eyes were treated with Cyclosporin A and followed up for （ 36.20 ± 7.95 ） months. The rejection rate was 100.00%. After treatment of Tacrolimus eye drops, the grafts of 5 eyes were transparent and followed up for （ 13.40 ± 3.17） months. In the follow-up period, rejection occurred in 1 eye（20.00% ）. Conclusion Tacrolimus eye drops is applied for preventing rejection in high-risk keratoplasty patients with poor response to Cyclosporin A eye drops, most patients can get better anti-immune rejection effects.