Intracameral route alternative for endothelial graft rejection refractory to conventional steroid therapy

Intracameral triamcinolone acetonide may be an additional modality to consider for thetreatment of endothelial allograft rejection when corticosteroid therapy administered viatraditional routes fail, said Renée D. Solomon, MD.

Dr. Solomon presented the findings from a prospective, longitudinal investigation of theefficacy and safety of intracameral triamcinolone in eyes that failed conventional steroidtherapy for penetrating keratoplasty rejection. Data were reviewed from a total of five eyes,said Dr. Solomon, a private practitioner in Long Island, NY.

At 2 weeks after the intracameral injection, partial resolution of microcystic edema andendothelial rejection lines was noted in three eyes. At a follow-up evaluation conducted after4 months. Uncorrected visual acuity had improved in three of the five eyes and was accompaniedby complete resolution of endothelial precipitates and stromal edema. There were no episodes ofIOP elevation associated with the intracameral steroid injection.

"Corneal endothelial graft rejection is a common complication after PKP," Dr. Solomon said."Corticosteroid therapy via the topical, periocular, and/or systemic route represents theaccepted treatment for acute allograft rejection. Other immunosuppressive agents have been usedwith varying results, but the next line of intervention has not been well established.

"Further study of intracameral corticosteroid is warranted, including evaluations of theoptimum dose, dilution, timing, and efficacy compared with alternate regimens for the treatmentof acute graft rejection," she said.