Related Experiment Video
Updated: May 11, 2026
Murine Corneal Transplantation: A Model to Study the Most Common Form of Solid Organ Transplantation
Published on: November 17, 2014
[Present state of the art in topical and systemic immunosuppression after keratoplasty]
E Bertelmann1, N Torun, U Pleyer
1Augenklinik, Charité Campus Virchow Klinikum, Universitätsmedizin, Augustenburger Platz 1, Berlin. eckart.bertelmann@charite.de
Abstract:
Today MMF can be considered as standard treatment besides cyclosporin A for immunosuppression after high-risk perforating keratoplasty. The efficacy of systemic MMF for this indication has been documented in several clinical studies including multicentre designs. Whether or not MPA therapy offers further advantages is currently under discussion. Sirolimus and tacrolimus are effective but could not achieve clinical importance due to higher rates of side effects. An additional benefit of combination therapies is not proven by clinical studies up to date. Everolimus shows pre-clinically a promising immunosuppressive and antiproliferative effect. Topical preparations of immunosuppressants as monotherapy are obviously insufficient as alternatives for systemic immunosuppressive therapy. Whether or not topical combination therapies will become established as alternatives to systemic treatment has to be demonstrated in the following years.
Insights
Mycophenolate mofetil (MMF) is a standard immunosuppressant for high-risk keratoplasty. While effective, its advantages over MPA therapy and the role of topical treatments require further investigation.
Area of Science:
- Ophthalmology
- Immunosuppression
- Transplantation
Context:
- High-risk perforating keratoplasty necessitates effective immunosuppression.
- Systemic mycophenolate mofetil (MMF) is a current standard treatment alongside cyclosporin A.
- The efficacy of systemic MMF is supported by multiple clinical studies.
Purpose:
- To evaluate the current landscape of immunosuppressive therapies post-keratoplasty.
- To discuss the potential benefits of MPA therapy.
- To assess the clinical relevance and side effect profiles of sirolimus and tacrolimus.
- To explore the efficacy of combination therapies and topical immunosuppressant preparations.
Summary:
- Systemic MMF is established for high-risk keratoplasty, but MPA therapy's advantages are under investigation.
- Sirolimus and tacrolimus show efficacy but have limited clinical use due to side effects.
- Current evidence does not support additional benefits from combination therapies.
- Topical immunosuppressants as monotherapy are insufficient; their role in combination therapy requires further study.
Impact:
- Informs clinical decisions regarding immunosuppression strategies after keratoplasty.
- Highlights areas for future research in optimizing post-transplant outcomes.
- Contributes to understanding the balance between efficacy and side effects of various immunosuppressants.
