[The observation of tacrolimus eye drops preventing the early immunological rejection after penetrating keratoplasty for fungal keratitis].

Objective: To observe the early immunological rejection prevention effect of tacrolimus eye drops combined with glucocorticoids on fungal keratitis patients who received penetrating keratoplasty (PKP). Methods: In a retrospective case series study, medical records of fungal keratitis patients who received PKP in Shandong Eye Institute from March 2013 to December 2015 were reviewed. Twenty-six patients (26 eyes) were given tacrolimus eye drops, and 24 patients (24 eyes) were given 1% cyclosporine A eye drops immediately after PKP. Two weeks after PKP, these patients were given low concentration of glucocorticoids if no fungal recurrence was found. Immune rejection, fungal recurrence, intraocular pressure, and drug irritation symptoms were monitored. Data were analyzed by chi-square test and independent t-test. Results: The average follow-up was 7 months (range, 3 to 12 months) postoperatively. The rejection rate was 15.3% in the tacrolimus group and 47.8% in the cyclosporine A group (χ(2)=5.510, P<0.05). One patient in the tacrolimus group and two patients in the cyclosporine A group suffered fungal recurrence. Two patients in the tacrolimus group and four patients in the cyclosporine A group had secondary glaucoma. The intraocular pressure was controlled. Three patients receiving tacrolimus eye drops and 13 patients receiving cyclosporine A eye drops had mild irritation symptoms. Conclusions: Tacrolimus eye drops combined with low concentration of glucocorticoids can prevent the early immunological rejection after PKP for fungalkeratitis effectively and safely. (Chin J Ophthalmol, 2017, 53:305-310).目的： 观察他克莫司滴眼液对真菌性角膜炎患者穿透性角膜移植术（PKP）后早期免疫排斥反应的预防作用。 方法： 回顾性系列病例研究。收集2013年3月至2015年12月于山东省眼科研究所确诊为真菌性角膜炎接受PKP术后立即局部应用他克莫司滴眼液的患者26例（26只眼）及术后立即局部应用1%环孢素A滴眼液的患者24例（24只眼）。所有患者术后2周若未发现真菌复发开始局部联合使用低浓度糖皮质激素滴眼液。对术后免疫排斥反应发生、真菌感染复发、眼压、用药刺激症状等进行观察。采用χ(2)检验对免疫排斥反应发生率进行统计学分析，采用独立样本t检验对计量资料进行统计学分析。 结果： 手术后平均随访7个月（3~12个月）。随访期内，他克莫司组免疫排斥反应发生率为15.3%（4/26），而环孢素A组为47.8%（11/24）（χ(2)=5.510，P<0.05）。他克莫司组1例患者、环孢素A组2例患者术后发生真菌感染复发。他克莫司组2例患者、环孢素A组4例患者出现继发性青光眼。他克莫司组3例患者局部应用他克莫司滴眼液后出现轻微灼热刺激症状，环孢素A组13例患者局部应用环孢素A滴眼液后出现轻微灼热刺激症状。 结论： 他克莫司滴眼液可以有效防治真菌性角膜炎患者PKP术后早期免疫排斥反应发生，安全性好。（中华眼科杂志，2017，53：305-310）.