각막이식 거부반응 고위험군에서 전층각막이식술 후저용량 사이클로스포린 투약에 따른 이식실패율
The Efficacy of Low-Dose Systemic Cyclosporine for Graft Failure after Penetrating Keratoplasty in High-Risk Group
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목적: 각막이식 거부반응의 고위험군 환자에서 전층각막이식술 시행 후 저용량 cyclosporine (CsA) 복용이 이식실패비율에 미치는영향에 대하여 알아보고자 하였다. 대상과 방법: 각막이식 거부반응 고위험군에서 전층각막이식술을 시행받은 25명 36안을 대상으로 저용량 CsA 복용여부에 따라 CsA복용군(n=19)과 대조군(n=17)으로 분류하여, 수술 후 2년간의 이식실패율을 비교하고 CsA 투약군에서 부작용 발생 비율을 조사하였다. 추가 분석으로 2회 이상 각막이식을 받은 환자를 CsA 복용군(n=9)과 대조군(n=9)으로 나누어 저용량 CsA 복용여부에 따른 술후 2년간의 이식실패율을 비교하였다. 결과: 각막이식수술 2년 후 이식실패율은 저용량 CsA 복용군에서 31.6%, 대조군에서 68.4%로, 통계적으로 유의한 차이가 없었으나(p=0.311), 그 중 2회 이상의 반복각막이식술을 받은 군에서는 수술 후 2년간 이식실패율이 저용량 CsA 복용군에서는 22.2%로 77.8%인 대조군에 비해 유의하게 낮았다(p=0.018). 또한 2년간의 경과관찰 중 1예(5.26%)에서만 위장장애로 투약을 중단하였다. 결론: 각막이식 거부반응 고위험군에서 전층각막이식술 후 저용량 CsA 복용은 2년간의 이식실패율에 영향을 주지는 않았으나, 부작용은 5.26%로 기존 연구들에 비해 적었으며, 2회 이상의 반복각막이식술 군에서는 이식실패율을 줄이는 것으로 나타났다. 2회 이상의반복각막이식술 군에서는 저용량 CsA복용을 고려해 볼 수 있으며, 이에 대한 추가적 연구가 필요할 것으로 생각한다.
Abstract
Purpose: To investigate the effect of low-dose systemic cyclosporine A (CsA) in preventing graft failure after high-risk penetratingkeratoplasty (PKP). Methods: In this retrospective study, 36 eyes of 25 patients who underwent PKP were evaluated. At 24 months postoperatively,the failure rate in the CsA group (n = 19) was compared to the control group (n = 17). For subgroup analysis,the failure rate in the CsA group (n = 9) and control group (n = 9) was compared in patients who underwent a repeat PKP. The patients’ side-effect profile was also collected. Results: The median follow-up in the CsA group was 32.8 months and 28.9 months in the control group. Graft failure occurredin 31.6% CsA patients and in 68.4% control patients (p = 0.311). In patients with repeat PKP, the failure rate in theCsA group was significantly lower than the control group (22.2% vs. 77.8%, p = 0.018). In one case (5.26%), CsA was discontinueddue to gastroinstestinal discomfort. Conclusions: Low-dose CsA was not beneficial compared to conventional therapy in high-risk PKP patients. However, inthe repeat PKP subgroup, the incidence of graft failure was lower with low-dose CsA than with conventional therapy. Although further study is necessary, adding low-dose CsA might be beneficial for repeat PKP patients.
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