Immunosuppressive Drugs Qnd Ocular Complications After Kidney Transplantation
Özet
Kidney transplantation is the treatment of choice for patients with end-stage renal disease and has substantially improved long-term survival and quality of life. The success of transplantation, however, relies on lifelong immunosuppressive therapy, which is associated with a wide range of systemic adverse effects, including potentially vision-threatening ocular complications. As the life expectancy of transplant recipients continues to increase, recognition and prevention of drug-related ocular morbidity have become increasingly important components of comprehensive post-transplant care. Ocular complications in kidney transplant recipients arise through multiple mechanisms, including direct pharmacologic toxicity, microvascular dysregulation, neurotoxicity, impaired tissue repair, and increased susceptibility to opportunistic infections. This chapter provides a comprehensive and clinically oriented overview of ocular complications associated with the major classes of immunosuppressive agents used in renal transplantation, including corticosteroids, calcineurin inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and antimetabolites. Corticosteroids remain the most common cause of ocular morbidity, frequently leading to posterior subcapsular cataract, steroid-induced glaucoma, and central serous chorioretinopathy. Calcineurin inhibitors, particularly tacrolimus and cyclosporine, may produce neuro-ophthalmic complications such as toxic optic neuropathy and posterior reversible encephalopathy syndrome. In contrast, mTOR inhibitors primarily affect ocular surface integrity and wound healing, whereas antimetabolites contribute mainly to ocular pathology through indirect mechanisms related to immunosuppression and opportunistic infections. Early recognition of immunosuppressive drug–related ocular complications is critical for preventing irreversible visual impairment while maintaining adequate graft protection. Close collaboration between ophthalmologists, nephrologists, and transplant specialists remains essential to achieve the optimal balance between vision preservation and long-term graft survival.
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