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Immunosuppressive Therapy for High-Risk Corneal Transplant

  • Cornea (K Houser, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review summarizes the efficacy, clinical utility, and adverse event profile of available immunosuppression agents used for high-risk keratoplasties. New studies are emphasized.

Recent Findings

Recent studies have highlighted the use of different immunosuppressive agents in the setting of high-risk keratoplasty as well as supporting studies (e.g., immune privilege, panel reactive antibody, HLA matching, graft rejection, and large reviews on the topic). Specific agents studied were topical difluprednate, topical and systemic tacrolimus, topical and systemic cyclosporine, mycophenolate mofetil, methotrexate, and immunomodulatory anti-VEGF agents.

Summary

Due to loss of protective factors, high-risk keratoplasties benefit from immunosuppression to prolong graft survival. Aggressive topical immunosuppression with periocular/systemic corticosteroids and immunomodulatory agents are useful for initial high-risk keratoplasties. Any history of rejection will likely benefit more from adequate systemic immunosuppression. Additional long-term studies in this population are needed.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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  1. Asma M. Azam and Cameron B. Reinisch contributed equally as first author.

Authors and Affiliations

  1. Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA

    Asma M. Azam & Albert Y. Cheung

  2. Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA

    Cameron B. Reinisch & Edward J. Holland

  3. Cincinnati Eye Institute, Edgewood, KY, USA

    Edward J. Holland

  4. Virginia Eye Consultants, 241 Corporate Blvd, Norfolk, VA, 23502, USA

    Albert Y. Cheung

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Correspondence to Albert Y. Cheung.

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AYC has consulted for LayerBio and Sight Sciences. EJH has consulted for Alcon Laboratories, Allergan, Bausch and Lomb, Kala Pharmaceuticals, Mati Pharmaceuticals, and Senju Pharmaceuticals. AMA and CBR do not have any financial disclosures.

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Azam, A.M., Reinisch, C.B., Holland, E.J. et al. Immunosuppressive Therapy for High-Risk Corneal Transplant. Curr Ophthalmol Rep 10, 114–129 (2022). https://doi.org/10.1007/s40135-022-00298-0

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