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Keratoplasty postoperative treatment update.

Machiko Shimmura-Tomita¹, Shigeto Shimmura, Yoshiyuki Satake

¹*Department of Ophthalmology, Jichi Medical University, Saitama Medical Center, Saitama, Japan; †Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; and ‡Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

|October 10, 2013

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Long-term topical corticosteroids reduce rejection after corneal transplants. Systemic cyclosporine showed no benefit in high-risk cases, but tacrolimus prevented irreversible rejection.

Area of Science:

Ophthalmology
Immunosuppression
Transplantation

Background:

Immunosuppressive therapy is crucial post-keratoplasty, but protocols vary significantly.
Steroids and other immunosuppressants are commonly used with differing regimens.

Purpose of the Study:

To evaluate the efficacy and safety of different immunosuppressive strategies after keratoplasty.
To compare long-term topical corticosteroids, systemic cyclosporine, and systemic tacrolimus.

Main Methods:

Three prospective clinical trials were conducted: 1 randomized trial on topical steroids, 1 randomized trial on systemic cyclosporine, and 1 non-randomized trial on systemic tacrolimus.
A retrospective study identified risk factors for postkeratoplasty atopic sclerokeratitis.

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Main Results:

Long-term topical corticosteroids significantly reduced endothelial rejection compared to no steroids.
Systemic cyclosporine did not improve rejection rates or graft clarity in high-risk corneal transplants.
Systemic tacrolimus prevented irreversible rejection in eyes that failed cyclosporine.
Atopic dermatitis patients undergoing keratoplasty have a higher risk of postkeratoplasty atopic sclerokeratitis, associated with blepharitis and neovascularization.

Conclusions:

Long-term topical corticosteroids are effective in preventing endothelial rejection after penetrating keratoplasty.
Systemic cyclosporine is not effective for high-risk corneal transplants, whereas tacrolimus shows promise.
Prophylactic systemic corticosteroids or cyclosporine may be beneficial for high-risk atopic patients to prevent postkeratoplasty atopic sclerokeratitis.