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. 2017 Mar;5(1):38-48.
doi: 10.1007/s40135-017-0119-2. Epub 2017 Feb 2.

Update on the Management of High-Risk Penetrating Keratoplasty

Sayena Jabbehdari  1 , Alireza Baradaran Rafii  2 , Ghasem Yazdanpanah  1 , Pedram Hamrah  3 , Edward J Holland  4 , Ali R Djalilian  1
Affiliations

Update on the Management of High-Risk Penetrating Keratoplasty

Sayena Jabbehdari et al. Curr Ophthalmol Rep. 2017 Mar.

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 currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells 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.

Keywords: Cornea; Graft rejection; High risk; Immunosuppressive drugs; Ocular surface disorder; Penetrating keratoplasty.

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Conflict of interest statement

Compliance with Ethical Guidelines Conflict of Interest Ali Djalilian, Sayena Jabbehdari, Alireza Baradaran Rafii, Ghasem Yazdanpanah, Pedram Hamrah and Edward Holland declare no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Figure 1
Figure 1
Total corneal conjunctivalization and vascularization after a severe alkaline chemical burn.
Figure 2
Figure 2
High risk penetrating keratoplasty in a patient with extensive peripheral anterior synechiae formation.
Figure 3
Figure 3
Penetrating keratoplasty in a patient after cultivated limbal epithelial transplantation (CLET). (a) Before CLET. (b) Six months after CLET. (c) Three months after PKP. (d) A year and a half after PKP.
See this image and copyright information in PMC

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