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New Developments in Topical and Systemic Immunomodulation Following Penetrating Keratoplasty

  • Chapter
Book cover Cornea and External Eye Disease

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Core Messages

  • Immunologic rejection is the main cause of corneal graft failure.

  • Acute rejection is mainly mediated by T cells, and can be prevented with steroids, IL-2 inhibitors (cyclosporine, tacrolimus), mycopheno-late mofetil, and TOR-inhibitors (everolimus, rapamycin).

  • Based on their risk of immunologic rejection, corneal transplants are rated as either normal-risk or high-risk transplants.

  • In a normal-risk situation, the postoperative application of topical steroids accompanied by a short course of systemic steroids is sufficient to prevent acute graft rejection in most cases.

  • In high-risk keratoplasty, systemic immunosuppression with mycophenolate mofetil or cyclosporine has to be used to maintain clear graft survival.

  • Topical immunosuppression with either cyclosporine A or tacrolimus might present an attractive therapeutic approach to reduce drug-specific systemic side effects.

  • More specific approaches using monoclonal antibodies, which target only selected aspects of the host's immune response, have failed to safely and sufficiently prolong graft survival in experimental settings, and have therefore not gained clinical relevance.

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Authors and Affiliations

  1. Augenwerk Optik, Landstraße 310, FL-9495 Triesen/Vaduz, Principality of Liechtenstein

    Alexander Reis

  2. Professor and Chairman of the University Eye Hospital, Killianstraße, Freiburg, 5, 79106, Germany

    Thomas Reinhard

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  1. Alexander Reis
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Editors and Affiliations

  1. University Eye Hospital, Killianstraβe 5, Freiburg, 79106, Germany

    Thomas Reinhard (Professor and Chairman) (Professor and Chairman)

  2. Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, United Kingdom

    Frank Larkin

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Reis, A., Reinhard, T. (2010). New Developments in Topical and Systemic Immunomodulation Following Penetrating Keratoplasty. In: Reinhard, T., Larkin, F. (eds) Cornea and External Eye Disease. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-85544-6_3

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