Topical cyclosporine in corneal transplantation.

Abstract

Corneal transplantation is the most commonly performed tissue transplantation boasting over a century of history, science, and tradition. One of the most promising immunomodulatory substances whose immunosuppressive effect has revolutionized solid organ transplantation is cyclosporine (CsA). We present a literature review on the role of topical cyclosporine in corneal transplantation. A review of the published literature using key databases that include MEDLINE and PubMed was undertaken. Published evidence base for the use of topical cyclosporine in corneal transplantation between 1986 and 2010 was evaluated and summarized. There is some scientific evidence to support the use of topical cyclosporine in appropriately selected cases of corneal transplantation. Although some encouraging human case series and case-control studies have been published, to date most randomized controlled trials evaluating the effects of topical cyclosporine in graft rejection prophylaxis and treatment have failed to demonstrate statistically significant improved outcomes. Cyclosporine cannot currently be considered as an effective sole agent in prophylaxis and treatment of allograft rejection, and corticosteroids therefore remain the gold standard choice of therapy. Further studies are required to refine the role of cyclosporine in modern corneal transplantation.