Advantages and limits of multiple grafts (third keratoplasty) under local cyclosporin 2%

Introduction. - Iterative penetrating keratoplasty procedures (PKPs) increase the risk of graft rejection. Surgeons are reluctant to perform a third procedure following two previous graft failures. We evaluated the outcomes of patients who had three successive PKPs treated with a local combination of cyclosporin 2% A and dexamethasone 0.1% eye drops. Patients and methods: - This is a retrospective study of a series of cases including 15 eyes of 15 patients treated and followed in the ophthalmology unit at the Hotel-Dieu Hospital in Paris (2006-2009). Results. - After an average follow-up of 20.5 +/- 2 months, the risk of transplant rejection was 13.33% and the duration of follow-up corresponded in all patients to the duration of treatment with cyclosporin eye drops. The treatment was not interrupted by any patient because of intolerance. Conclusion. - In this study, we observed a success rate justifying the indication of the third keratoplasty under local cyclosporin 2% classically considered debatable. (C) 2010 Published by Elsevier Masson SAS.