title: Management of high-risk corneal transplantation.
abstract: 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 grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of 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 used 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.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Zazzo
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Tulio B
authors.initials: TB
authors.lastname: Abud
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: Sunali
authors.initials: S
authors.lastname: Goyal
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: Reza_Dana@meei.harvard.edu.
authors.forename: Reza
authors.initials: R
authors.lastname: Dana
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D016510:Corneal Neovascularization / Q000150:complications / Q000188:drug therapy; D016039:Corneal Transplantation / Q000379:methods*; D003524:Cyclosporins / Q000627:therapeutic use; D019468:Disease Management; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use
chemical_list: D020533:Angiogenesis Inhibitors; D003524:Cyclosporins; D007166:Immunosuppressive Agents; D013256:Steroids
keywords: cornea; graft rejection; high-risk; immunosuppression; neovascularization; transplantation