Immunosuppressive Therapy for High-Risk Corneal Transplant

Azam, Asma M; Reinisch, Cameron B; Holland, Edward J.; Cheung, Albert Y.

doi:10.1007/s40135-022-00298-0

Cited by 3 publications

(1 citation statement)

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“…Cornea is the only transplant specialty that does not use the principles of immunosuppression, which are not needed for routine keratoplasty but are beneficial in high-risk keratoplasty (ie, previous graft rejection or stromal neovascularization) in addition to OSSTx. 62–95 The authors, as a group, have used SI on over 1000 patients and have seen minimal severe adverse events (rare cardiovascular disease and 1 secondary malignancy) and no deaths. We have published on our use of these medications and the protocol to adopt the principles of SI from organ transplantation experts, notably nephrology (the Cincinnati Protocol).…”

Section: Obstacles In Adoption Of Osstx With Simentioning

confidence: 99%

Why Are Corneal Specialists Resistant to Treating Patients Who Have Severe Ocular Surface Disease With Limbal Stem Cell Deficiency?

Holland

Cheung

Djalilian

et al. 2023

Cornea

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Purpose: To highlight the paucity of surgeons performing ocular surface stem cell transplantation with systemic immunosuppression (OSSTx with SI) for limbal stem cell deficiency (LSCD) patients, suboptimal treatments for LSCD, and obstacles to adoption. Methods: A review of the Eye Bank Association of America annual reports and the authors' case volume for OSSTx with SI was performed. Examination of the published literature on corneal surgeries, especially for LSCD, was completed. These findings were combined with our clinical observations to develop this editorial. Results: Despite techniques and protocols for OSSTx with SI published more than 30 years ago for the treatment of severe bilateral LSCD, only a small number of corneal specialists have adopted these techniques. There is a paucity of attention to this population of patients, with minimal publications to advance this area of our field. We are too often referred patients with LSCD and severe ocular surface disease that have had suboptimal treatments such as penetrating keratoplasties or primary keratoprostheses. Hesitancy for adopting OSSTx with SI is likely due to a lack of exposure to these procedures during training and fear of systemic immunosuppression. Corneal surgeons are likely unaware of the safety of systemic immunosuppression with appropriate monitoring especially when comanaging these patients with an organ transplant specialist. Conclusion: There is a large unmet need for the treatment of corneal blindness secondary to conjunctival and LSCD. For the vast majority of patients, OSSTx should be the first surgical choice to treat these eyes. We hope major ophthalmology centers will meet this need by building programs, and groups of corneal surgeons should collaborate to create regional centers to make this treatment more accessible to help this population.

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Section: Obstacles In Adoption Of Osstx With Simentioning

confidence: 99%