局部应用环孢霉素A防治角膜移植排异反应

用环霉孢素Ａ对１５例部分穿透性角膜移植病人局部滴眼预防及治疗角膜移植术后排异反应。角膜移植植片全部透明１３只眼，半透明２只眼，混浊１只眼，随访时间最长１．５年，最短半年，环孢霉素Ａ对角膜移植片的排异反应疗效满意，为今后开展角膜移植，提供了一种新型强效免疫抑制剂。     

局部应用环孢霉素A防治角膜移植排异反应

用环霉孢素Ａ对１５例部分穿透性角膜移植病人局部滴眼预防及治疗角膜移植术后排异反应。角膜移植植片全部透明１３只眼，半透明２只眼，混浊１只眼，随访时间最长１．５年，最短半年。环孢霉素Ａ对角膜移植片的排异反应疗效满意，为今后开展角膜移植，提供了一种新型强效免疫抑制剂。     

环孢霉素A局部应用治疗春季结膜炎

局部应用环孢霉素Ａ（ＣｓＡ）治疗春季结膜炎１２例，其中３例联合睑结膜乳头切除及冷冻治疗，收到了满意的效果，坚持用药半年以上，追踪观察１－３年，未见病情复发，治疗后Ｔ－淋巴细胞亚群中的ＯＫＴ３，ＯＫＴ８的均值有下降，观察结果表明ＣｓＡ局部滴眼，对于睑结膜有巨大乳头增生者联合乳头切除及冷冻治疗，对于用其它药物久治未愈者，是一种较好的治疗方法。     

局部应用环孢霉素A口服液防治角膜移植排斥反应的观察

为探讨环孢霉素Ａ口服液滴眼防治角膜移植排斥反应的可行性,我们观察了２０例２１眼高危角膜移植患者,穿透性角膜移植术后２０眼滴用１０％环孢霉素Ａ口服液原液,每晚一次。随访６～１４个月。结果２０例２０眼植片全部保持透明,未见严重毒副作用。一例双眼移植的患者未用环孢霉素Ａ眼发生排斥反应。表明国产环孢霉素Ａ口服液原液滴眼安全可靠,值得推广。     

环孢霉素A滴眼剂治疗角膜移植排斥反应

应用０．５％环孢霉素Ａ滴眼剂治疗穿透性角膜移植术后免疫排斥患者１５例（１５眼），愈８例，好转６例，无效１例。随防５～２４个月，２例因停药复发，一例于拆线后复发，继续用药或增加用药后治愈。研究表明０．５％环孢霉素Ａ滴眼剂治疗术前移植床条件较好，角膜移植术后发生免疫排斥的患者可得到良好的效果，而对术前移植床条件较差，角膜移植术后发生免疫排斥的患者有一定的疗效。对眼局部应用环孢霉素Ａ滴眼治疗角膜移植排斥     

环孢霉素A与角膜移植

环孢霉素A是一种很强的免疫抑制剂,其高效低毒的特点为以往任何一种免疫抑制剂所不及.它对多种动物的器官移植,都有免疫抑制效果。临床用于肾、肝和心脏等大型器官的移植,业已获得成功。自1979年以来,学者们开始研究环孢霉素A对角膜移植排斥反应的作用。许多学者对在角膜移植中应用环孢霉素的给药途径、时间和疗程等进行了探索,对其作用机理、药物动力学和副作用进行了报道,并对临床应用进行了观察,结果是令人鼓舞的,但也有不同意见。本文综述了这方面的一些研究情况。     

环孢霉素A在角膜移植中的应用进展

环孢霉素 A(cyclosporin A,Cs A)系含 11个氨基酸的环状多肽 ,是一种强效免疫抑制剂 ,对 T淋巴细胞亚群具有选择性抑制作用 ,同时还抑制白细胞介素 2、T细胞生长因子(TCGF)等细胞因子的释放。 Cs A与其他细胞抑制剂不同的是 :环孢霉素 A不抑制造血细胞 ,对吞噬细胞的功能亦无影响 ,因此患者较少发生感染 ,故已在骨髓移植、器官移植及其他免疫性疾病方面广泛应用。在眼科多种疾病的治疗如抑制角膜移植排斥反应、抑制角膜新生血管生成 ,治疗葡萄膜炎 [1 ,2 ]、增殖性玻璃体视网膜病变及巨细胞病毒性视网膜炎 [3]等方面也已有广泛应用并…     

Topical Cyclosporin A in the treatment of acute graft rejection: a randomized controlled trial

Background:  Corneal graft rejection is the commonest cause of graft failure. Currently, intensive topical steroid is the treatment for graft rejection. We hypothesized that the use of topical Cyclosporin A (CsA) 0.05%, specifically Restasis (Allergan) in addition to intensive steroids would aid in the reversal and treatment of endothelial graft rejection.
Methods:  In a randomized double masked control study, we recruited 108 patients with acute endothelial graft rejection. They were randomized to two groups. The first group received intensive prednisolone acetate and placebo. The second group received intensive prednisolone acetate and Restasis.
Results:  There was no difference between the baseline characteristics for the two groups. Nine out of 54 in the placebo group and five out of 54 (16.7% vs. 9.2% P  = 0.23) in the treatment group were exited from the study because of worsening signs despite treatment. No significant difference was found between the two groups for time to reversal and resolution. Side-effects of the treatment include increased intraocular pressure and punctate epithelial erosions. These changes most likely relate to the use of intensive prednisolone acetate.
Conclusion:  The use of commercially available CsA as an adjunct to topical steroids does not appear to improve the outcome of graft rejection.     

环孢霉素A(Cyclosporin A,CsA)对穿透性异种角膜移植的影响——免疫学检测与形态学观察

以鸡→兔穿透性角膜移植为实验模型,运用ELISA 技术和微量全血~3H—TdR 掺入法、光镜和扫描电镜进行检测和观察。结果:术后3～4周血清中抗角膜抗体水平和外周血淋巴细胞转化程度达峰值,而CsA 治疗组与对照组比,上述二项免疫指标水平都有明显下降。组织病理学检查:在对照组的移植片内出现明显的炎性细胞浸润和新生血管,而CsA 治疗组,异种植片基本正常,没有出现炎性细胞浸润和新生血管。     

Clinical Review: Topical Ophthalmic Use of Cyclosporin A

Cyclosporine A (CsA) is an immunomodulatory agent that primarily inhibits the proliferation and action of T cells. Systemic CsA has been used successfully in solid organ transplantation and noninfectious uveitis. Topical CsA with various formulations has been used in the field of ocular surface diseases since early 1980s. An ophthalmic emulsion 0.05% (Restasis, Allergan, Irvine, CA), was approved by the United States Food and Drug Administration in 2003 to treat dry eye syndrome. This article aims to evaluate the peer-reviewed published scientific literature and to define well-established uses of CsA eyedrops in the field of ocular surface diseases.     

角膜移植术后应用环孢霉素滴眼液的临床观察

目的对比研究穿透性角膜移植术不同术后处理方法及其术后排斥反应的发生率。方法2组（48例）行穿透性角膜移植术角膜病患者，一组术后单独使用0．1％地塞米松滴眼，另一组采用环孢霉素A（1％CsA）和0．1％地塞米松（0．1％DXM）联合滴眼，对比2组术后排斥反应的发生率。结果采用1％CsA联合0．1％DXM，术后治疗组排斥反应发生率明显低于单纯使用地塞米松组（P〈0．05）。结论术后采用CsA联合DXM治疗，可有效降低角膜移植术后的排斥反应发生率。     

穿透性角膜移植术后环胞霉素A与皮质类固醇的合理应用

目的：对透性角膜移植术后患者合理应用环胞霉素Ａ滴眼液代替地塞米松滴眼液的疗效和眼压进行评价。方法：４２０例穿透性角膜移植村后患者,随机分成两组。Ａ组：０．５％地塞米松滴眼液联合１％环胞霉素Ａ滴眼液,每天４次共３个月。Ｂ组：０．５％地塞米松滴眼液联合１％环胞霉素Ａ滴眼液,每天４次,共１个月,后改用１％环胞霉素Ａ滴眼液至３个月。对两组眼压和免疫排斥情况进行观察。结果：Ａ组５８例患者眼压〉２２ｍｍＨｇ,     

雷帕霉素滴眼液抑制大鼠角膜移植的免疫排斥反应

目的:研究雷帕霉素滴眼液眼局部应用对大鼠角膜移植免疫排斥反应的作用。方法:建立大鼠穿透性角膜移植动物模型,以SD大鼠为受体,Wistar大鼠为供体,分为A,B,C,D,E5组。手术后2d起分别以滴眼液基质、0.5g/L雷帕霉素滴眼液、1g/L雷帕霉素滴眼液、2g/L雷帕霉素滴眼液、10g/L环孢霉素A滴眼液滴眼,每次100μL,4次/d,用药至排斥反应发生。对角膜植片进行临床观察,以混浊、水肿和新生血管3项指标作为临床评估标准,并进行组织学检查。结果:角膜植片5组的存活时间分别为11.00±1.85d,19.71±3.86d,22.17±4.07d,31.71±8.44d及25.00±8.85d,各用药组与对照组比较差异有显著性(P<0.01);各浓度雷帕霉素组与环孢霉素A组比较差异无显著性(P>0.01)。组织学发现,术后14d各药物治疗组炎细胞浸润、新生血管形成及水肿程度均明显轻于对照组。结论:0.5,1及2g/L的雷帕霉素滴眼液均能显著延长角膜植片的存活时间,对大鼠穿透性角膜移植排斥反应具有抑制作用,随着药物浓度的增大抗排斥作用增强。     

Cyclosporin A in the ocular fluids of uveitis patients following long-term systemic administration

BACKGROUND/AIMS: To determine the levels of cyclosporin A (CsA) in tears and the anterior segment of the eye following long-term oral intake for autoimmune diseases. METHODS: Subjects taking oral CsA to treat relapsing autoimmune ocular inflammation were included in this study. All of the patients had been quiescent for at least 6 months. In patients scheduled for cataract extraction (group A), the CsA levels in the blood, aqueous humour and anterior capsule of the lens were determined. In subjects not requiring surgical intervention (group B), CsA was measured in tears and blood. The samples were analysed using turbulent flow chromatography coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: There were 19 subjects in group A and 43 subjects in group B. CsA was detectable in all of the tear samples with a mean value of 22.4 +/- 20.2 ng/ml and there was a significant positive correlation between the CsA levels in tears and blood (P = 0.012). CsA was not detected in any of the surgical samples. CONCLUSION: LC-MS/MS proved very sensitive for detecting CsA in low-volume biological samples. CsA was present in human tears in proportion to the blood level after an average of 12 hours from the last oral intake.     

Mooren角膜溃疡免疫治疗学研究

对5例7眼Mooren角膜溃疡治疗前后的OKT系列、LTT、IL-2及NK等免疫项目做了检测,同时应用Cs-A局部治疗。结果治疗前Mooren角膜溃疡病人的QKT_4/OKT_8比值、IL-2明显高于正常组。治疗后OKT_4/OKT_8比值及IL-2比治疗前明显降低,其它项目检查无明显变化。提示本病与自身免疫有关,Cs-A是治疗Mooren角膜溃疡的有效药物。     

增视性角膜移植术及其排斥反应防治的临床观察

角膜移植病人２５５例（２６５眼），植片透明率达９６．０９％，混浊者占３．９１％，术前视力均在０．１以下，术后视力提高率为９０．８３％，达到当前国内最佳水平，眼局部滴用环孢霉素Ａ，有明显防治排斥反应作用。