[Corneal allograft rejection: topical treatment vs. pulsed intravenous methylprednisolone - ten years' result]. / Rejeição de transplantes de córnea: tratamento tópico vs. pulsoterapia - resultados de 10 anos.

PURPOSE: To evaluate the efficacy of intravenous 500 mg methylprednisolone in addition to topical treatment with 1% prednisolone in the treatment of the first episode of corneal endothelial rejection in patients that were submitted to corneal allograft transplantation. METHODS: Retrospective case-control study with 81 patients that presented the first episode of corneal endothelial rejection and were treated within the first 15 days of the onset of symptoms. RESULTS: 67 patients were treated with 1% topical prednisolone acetate and pulsed intravenous methylprednisolone 500 mg at the diagnosis of corneal allograft rejection. Fourteen patients were submitted to topical treatment only, thus forming the control group. Forty-one of 67 patients (61.2%) that were submitted to pulsed steroid had good outcome and 26 (38.8%) presented corneal graft failure while only 4 of 14 patients (28.57%) that received only topical steroids evolved with clear grafts and the remaining 10 patients (71.43%) with graft failure. Chi-square showed statistically significant association (p<0.05) to greater success with pulsed methylprednisolone. CONCLUSIONS: This study suggests that the use of 500 mg intravenous methylprednisolone in addition to 1% topical prednisolone acetate for the treatment of endothelial corneal allograft rejection presents better outcomes in reverting corneal allograft rejection when compared to isolated use of 1% topical prednisolone acetate.

Rejeição de transplantes de córnea: tratamento tópico vs. pulsoterapia - resultados de 10 anos / Corneal allograft rejection: topical treatment vs. pulsed intravenous methylprednisolone - ten years' result

OBJETIVOS: Avaliar a eficácia da associação de pulsoterapia com 500 mg de metilprednisolona intravenosa ao acetato de prednisolona 1 por cento tópico no tratamento do primeiro episódio de rejeição endotelial de transplantes de córnea. MÉTODOS: Estudo caso-controle retrospectivo com 81 sujeitos que apresentaram o primeiro episódio de rejeição endotelial e submetidos à terapia nos primeiros quinze dias dos sintomas. RESULTADOS: 67 sujeitos foram tratados com acetato de prednisolona 1 por cento tópico de 1 em 1 hora e pulsoterapia com 500 mg de metilprednisolona intravenosa no dia do diagnóstico e 14 sujeitos foram submetidos apenas ao tratamento com acetato de prednisolona 1 por cento tópico formando o grupo controle. Dos 67 sujeitos submetidos a corticoterapia venosa e tópica, 41 (61,19 por cento) evoluíram satisfatoriamente e 26 (38,8 por cento) apresentaram falência endotelial. Dos 14 sujeitos submetidos apenas à corticoterapia tópica, 4 (28,57 por cento) evoluíram com enxerto transparente e os 10 restantes (71,43 por cento) com falência endotelial. O teste do qui-quadrado apontou maior taxa de sucesso (p<0,05) na reversão da rejeição endotelial do transplante de córnea no grupo submetido à pulsoterapia. CONCLUSÕES: O estudo sugere que o tratamento da rejeição endotelial de transplantes de córnea com pulsoterapia e corticóide tópico apresenta maior taxa de sucesso em relação ao uso isolado de corticóide tópico.

PURPOSE: To evaluate the efficacy of intravenous 500 mg methylprednisolone in addition to topical treatment with 1 percent prednisolone in the treatment of the first episode of corneal endothelial rejection in patients that were submitted to corneal allograft transplantation. METHODS: Retrospective case-control study with 81 patients that presented the first episode of corneal endothelial rejection and were treated within the first 15 days of the onset of symptoms. RESULTS: 67 patients were treated with 1 percent topical prednisolone acetate and pulsed intravenous methylprednisolone 500 mg at the diagnosis of corneal allograft rejection. Fourteen patients were submitted to topical treatment only, thus forming the control group. Forty-one of 67 patients (61.2 percent) that were submitted to pulsed steroid had good outcome and 26 (38.8 percent) presented corneal graft failure while only 4 of 14 patients (28.57 percent) that received only topical steroids evolved with clear grafts and the remaining 10 patients (71.43 percent) with graft failure. Chi-square showed statistically significant association (p<0.05) to greater success with pulsed methylprednisolone. CONCLUSIONS: This study suggests that the use of 500 mg intravenous methylprednisolone in addition to 1 percent topical prednisolone acetate for the treatment of endothelial corneal allograft rejection presents better outcomes in reverting corneal allograft rejection when compared to isolated use of 1 percent topical prednisolone acetate.