Corneal endothelial rejection after penetrating keratoplasty treated with intravenous and topic corticosteroid: one year follow up Tratamento da rejei o endotelial pós-ceratoplastia penetrante através da associa o do pulso de metilprednisolona intravenosa com acetato de prednisolona tópico: seguimento de um ano

OBJECTIVE: To analyze the recovery of visual acuity (VA) and graft survival after first episode of endothelial rejection in penetrating keratoplasty (PKP) treated with intravenous (IV) and topic corticosteroid. METHODS: Interventional, prospective, non-comparative case series study evolving 32 PKP patients in one year follow up, who presented first episode of corneal endothelial rejection. The patients were submitted to 500 mg IV injection of methylprednisolone in association with topical prednisolone. Main outcome measures included VA recovery and corneal edema regression. Second outcome included new rejections and graft failure. Multivariate analysis techniques were used to estimate rates of graft outcome events and the impact of risk factors. RESULTS: A total of 32 eyes from 32 patients (13 male and 19 female) were included in the study. The mean VA (in number of letters) before rejection was 48 (22 to 88 letters). Patients treated within 7 days or less of initial symptoms had better VA recovery, corneal edema regression and less graft failure (p<0.001). Patients with previous ocular surgery had worse VA recovery and more graft failure (p<0.047). CONCLUSION: The association between the other risk factors and the outcomes did not reach statistical significance in the multivariate model because of the small numbers of patients. Methylprednisolone in association with topical prednisolone is an alternative treatment for graft rejection. Our study showed that patients treated within 7 days of symptoms and no previous anterior segment surgery had better visual outcome and graft survival after treatment. OBJETIVO: Analisar a recupera o da acuidade visual (AV) e sobrevivência do enxerto após primeiro episódio de rejei o endotelial em ceratoplastia penetrante (PK) em pacientes submetidos ao corticóide intravenoso (IV) associado ao tópico. MéTODOS: Estudo descritivo, prospectivo, tipo série de casos envolvendo 32 pacientes com PK tratados com 2 doses de 500mg de metilprednisolona IV (com intervalo de 1 semana) associado ao acetato de prednisolona 1%. O parametro principal analisado foi a recupera o da AV e a regress o do edema corneano. O parametro secundário utilizado foi a recorrência das rejei es e a falência do enxerto. RESULTADOS: Um total de 32 olhos de 32 pacientes foram incluídos no estudo (13 homens e 19 mulheres). A média da AV (em número de letras) foi 48. Pacientes tratados dentro de 7 dias ou menos após o surgimento dos sintomas apresentaram melhor recupera o da AV e menor falência do enxerto (p<0,001). Pacientes com antecedente de cirurgia o