Update on the Management of High-Risk Penetrating Keratoplasty

被引：35
作者：
Jabbehdari S. [1 ]
Baradaran-Rafii A. [2 ]
Yazdanpanah G. [1 ]
Hamrah P. [3 ]
Holland E.J. [4 ]
Djalilian A.R. [1 ]
机构：
[1] Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, 60612, IL
[2] Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran
[3] Department of Ophthalmology, Tufts University Medical School, Boston, MA
[4] Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH
来源：
Current Ophthalmology Reports | 2017年 / 5卷 / 1期
关键词：
Cornea; Graft rejection; High risk; Immunosuppressive drugs; Ocular surface disorder; Penetrating keratoplasty;
D O I：
10.1007/s40135-017-0119-2
中图分类号：
学科分类号：
摘要：
Purpose of Review: In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Recent Findings: Despite the immune privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cell transplantation is employed. Summary: Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents, e.g., tacrolimus, cyclosporine, and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts. © 2017, Springer Science + Business Media New York.
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页码：38 / 48
页数：10
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