Use of repository corticotropin injection for the prophylaxis of corneal graft rejection in high-risk patients: A case series.

INTRODUCTION

Graft rejection is the leading cause of corneal allograft failure. Prompt recognition followed by aggressive steroid therapy are key elements in the treatment of graft rejection; however, prolonged corticosteroid use carries an unfavorable safety profile. Repository corticotropin injection (RCI) is United States Food and Drug Administration (FDA)-approved for the treatment of several inflammatory disease states and is indicated for use in severe ophthalmic acute and chronic allergic and inflammatory processes. In this consecutive, observational case report we provide descriptive results of the use of RCI as prophylaxis for corneal graft rejection in high-risk patients.

PRESENTATION OF CASES: Eligible high-risk patients were administered 80 units of RCI subcutaneously twice weekly beginning one-month pretransplant. Preoperative visual acuity (VA) and postoperative intraocular pressure, graft integrity, and VA values were collected for all patients.

DISCUSSION: The majority of patients (87.5 %) receiving RCI demonstrated maintenance or improvement of VA post-keratoplasty as well as post-operative intraocular pressures that fell within the normal range. Upon postoperative examination, the majority of patients (6/8; 75 %) treated with RCI maintained a clear graft quality with no signs of rejection. No treatment-emergent adverse effects were reported by the patients during treatment with RCI.

CONCLUSION

The use of RCI prophylactically in high-risk, post-keratoplasty patients demonstrated maintenance or improvement in VA in the majority of patients. The results of this study also showed that RCI was safe and well tolerated, which is consistent with the known safety profile of RCI.