Update on the management of high-risk penetrating keratoplasty
S Jabbehdari, A Baradaran-Rafii… - Current ophthalmology …, 2017 - Springer
Current ophthalmology reports, 2017•Springer
Abstract Purpose of Review In this article, we review the indications and latest management
of high-risk penetrating keratoplasty. Recent Findings Despite the immune privilege status of
the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft
failure. This is particularly a problem in the high-risk graft recipients, namely patients with
previous graft failure due to rejection and those with inflamed and vascularized corneal
beds. A number of strategies including both local and systemic immunosuppression are …
of high-risk penetrating keratoplasty. Recent Findings Despite the immune privilege status of
the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft
failure. This is particularly a problem in the high-risk graft recipients, namely patients with
previous graft failure due to rejection and those with inflamed and vascularized corneal
beds. A number of strategies including both local and systemic immunosuppression are …
Purpose of Review
In this article, we review the indications and latest management of high-risk penetrating keratoplasty.
Recent Findings
Despite the immune privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cell transplantation is employed.
Summary
Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents, e.g., tacrolimus, cyclosporine, and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.
Springer
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