Prevention and Treatment of Corneal Graft Rejection

Kharod-Dholakia, Bhairavi; Randleman, J. Bradley; Bromley, Jennifer G.; Stulting, R. Doyle

doi:10.1097/ico.0000000000000403

Cited by 60 publications

(33 citation statements)

References 22 publications

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“…Surprisingly, the usage of subconjunctival steroid preparations was noted to be higher in routine management of low-risk grafts (76%) than in high-risk grafts (54%); this may be related to the use of other topical and oral immunosuppressive agents in high-risk grafts. 82 …”

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

“…82,123,124 However, no randomized clinical trial has been performed to assess the efficacy of this therapy. The Bowman Club Survey in the United Kingdom demonstrated that 44% of corneal surgeons use systemic immunosuppression including oral prednisolone for 1 day to 12 months postoperatively in high-risk cases.…”

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

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Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

124

102

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The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal graft has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates due to a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered. However, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been employed for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments as well as tolerance-inducing methods show promising horizons in the management of high-risk corneal transplantation in near future.

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Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

Section: Management Of High-risk Corneal Transplantationmentioning

confidence: 99%

Management of high-risk corneal transplantation

Zazzo

Kheirkhah

Abud

et al. 2017

Survey of Ophthalmology

124

102

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“…Surveys indicate that prednisolone acetate 1% is the preferred topical steroid for the prevention of transplant rejection. [7][8][9] Loteprednol etabonate differs from other corticosteroids because it has an ester instead of a ketone at the C-20 position of the core corticosteroid structure. 6 After ocular penetration, unbound loteprednol etabonate undergoes rapid deesterification to an inactive metabolite, which is believed to reduce the potential impact on intraocular pressure (IOP).…”

mentioning

confidence: 99%

Loteprednol Etabonate 0.5% Gel Vs. Prednisolone Acetate 1% Solution After Descemet Membrane Endothelial Keratoplasty

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Feng

Scanameo

et al. 2015

Cornea

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“…[20] In the past, this treatment has proven effective in improving survival rates of LR corneal transplantation patients. [21] However, the duration of prophylactic treatment with topical corticosteroids is still variable among surgeons.…”

Section: High-risk Corneal Transplantationmentioning

confidence: 99%

“…[21] However, the duration of prophylactic treatment with topical corticosteroids is still variable among surgeons. [20]…”

Section: High-risk Corneal Transplantationmentioning

confidence: 99%

Systemic immunomodulatory strategies in high-risk corneal transplantation

Abud¹,

Zazzo²,

Kheirkhah³

et al. 2017

J Ophthalmic Vis Res

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The cornea is the most commonly transplanted tissue in the body. Although corneal grafts generally have high success rates, transplantation onto inflamed and vascularized host beds, or so-called high-risk corneal transplantation, has a high rate of graft rejection. The management of this high-risk corneal transplantation is challenging and involves numerous measures. One of the key measures to prevent graft rejection in these cases is the use of systemic immunosuppressive agents. In this article, we will review the systemic immunosuppressive agents most commonly used for high-risk corneal transplantation, which include corticosteroids, cysclosporine A, tacrolimus, mycophenolate mofetil, and rapamycin. Benefits, risks, and published data on the use of these medications for high-risk corneal transplantation will be detailed. We will also summarize novel immunoregulatory approaches that may be used to prevent graft rejection in high-risk corneal transplantation.

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Prevention and Treatment of Corneal Graft Rejection

Cited by 60 publications

References 22 publications

Management of high-risk corneal transplantation

Management of high-risk corneal transplantation

Loteprednol Etabonate 0.5% Gel Vs. Prednisolone Acetate 1% Solution After Descemet Membrane Endothelial Keratoplasty

Systemic immunomodulatory strategies in high-risk corneal transplantation

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