Efficacy of Postoperative Systematic Immunosuppression with Methotrexate in High Risk Penetrating Keratoplasty

Shilpa Joshi, Neha S Sharma and Col M Deshpande

Department of Cornea, H. V. Desai Eye Hospital, India

^*Correspondance to: Shilpa Joshi 

 PDF  Full Text DOI: 10.25107/2474-1647.2420

Abstract

Aim: To compare the outcome of high risk penetrating Keratoplasties in patients on postoperative oral methotrexate with patients on standard regimen.
Design: Retrospective comparative case series.
Materials and Methods: Data was obtained by reviewing case records of high risk optical Penetrating Keratoplasty (PK) patients operated between Jan 2016 to Dec 2018 at our institute (P.B.M.A.’s H.V. Desai Eye Hospital) and who followed up for at least six months. Pediatric, therapeutic, tectonic and lamellar Keratoplasties were excluded. High risk cases had one or more of the following criterias: 1) previous failed grafts 2) presence of >2 quadrant stromal vascularization 3) unstable ocular surface 4) disorganized anterior segment 5) total corneal scars with no view of anterior chamber. Of the total 33 cases, 21 receive oral methotrexate whereas 12 cases were in the control group.
Results: The mean follow up was 73.14 weeks in methotrexate group and 71.33 in control group. There were totally 13 clear grafts (Clarity- Grade 4-3) in methotrexate group (61.9%) and only 4 in the control group (33.33 %). Patients on systemic Methotrexate were found to have a statistically significant chance of having a grade 4 clear graft as compared to the control group. (Two sided test P value=0.0374). It was also found that patients with multiple high risk factors on systemic Methotrexate were found to have a statistically significant chance of having grade 4 clear grafts as compared to the control group. (Two sided test P value=0.0197).
Conclusion: Systemic immunosuppression with oral methotrexate has shown some promising results in the postoperative management of high risk P.K.s in our series. The efficacy, safety and cost of this drug makes it a very viable option especially in patients with multiple high risk factors who form the major chunk of all cases of P.K.s done in the developing countries.

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Cite the article

Joshi S, Sharma NS, Deshpande CM. Efficacy of Postoperative Systematic Immunosuppression with Methotrexate in High Risk Penetrating Keratoplasty. Clin Surg. 2019; 4: 2420.