Use of Topical Cyclosporine 0.1% in Therapeutic Penetrating Keratoplasty for Fungal Keratitis

Purpose: The efficacy and safety of topical cyclosporine 0.1% in preventing early graft failure after therapeutic penetrating keratoplasty (TPK) in eyes with fungal keratitis were evaluated. Methods: This prospective case series included patients with fungal keratitis undergoing TPK from May to December 2019 who were treated with cyclosporine A 0.1% eye drops (tCSA group). We compared the outcome with a historical cohort of patients who were treated conventionally (CT group) with topical prednisolone acetate 1% eye drops started 3 weeks after surgery. Results: There were 20 patients (male: 13; female: 7) in the tCSA group and 28 patients in the CT group (male: 23; female: 5). The number of clear grafts 3 months postoperatively was 10 (50%) in the tCSA group and 4 (14.3%) in the CT group (P = 0.011). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 1.49 +/- 0.74 in the tCSA group and 2.10 +/- 0.62 in the CT group (P = 0.003). There were 5 patients (17.9%) with recurrence of the primary fungal infection in the CT group, 4 of whom were using topical prednisolone. There was no recurrence in the tCSA group. A logistic regression analysis revealed higher odds of a clear graft at 3 months postoperatively with topical cyclosporine 0.1% [odds ratio: 14.35 (95% confidence interval, 2.38-86.5), P = 0.004]. Conclusions: Postoperative treatment with topical cyclosporine 0.1% seems to increase graft survival and postoperative vision with reduced risk of recurrence of primary infection in eyes with fungal keratitis undergoing TPK.