Immunosuppressive Therapy for High-Risk Corneal Transplant

Purpose of Review This review summarizes the efficacy, clinical utility, and adverse event profile of available immunosuppression agents used for high-risk keratoplasties. New studies are emphasized. Recent Findings Recent studies have highlighted the use of different immunosuppressive agents in the setting of high-risk keratoplasty as well as supporting studies (e.g., immune privilege, panel reactive antibody, HLA matching, graft rejection, and large reviews on the topic). Specific agents studied were topical difluprednate, topical and systemic tacrolimus, topical and systemic cyclosporine, mycophenolate mofetil, methotrexate, and immunomodulatory anti-VEGF agents. Summary Due to loss of protective factors, high-risk keratoplasties benefit from immunosuppression to prolong graft survival. Aggressive topical immunosuppression with periocular/systemic corticosteroids and immunomodulatory agents are useful for initial high-risk keratoplasties. Any history of rejection will likely benefit more from adequate systemic immunosuppression. Additional long-term studies in this population are needed.