Cornea & Ocular Surface

Topical Cyclosporine May Increase Corneal Graft Survival

Avatar photoJodi McCaffrey, MA, FACHE
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Ophthalmic Training charity Orbis Carries Out Work With Local Eye-Care Teams In Peru
TRUJILLO, PERU – APRIL 18: Corneal edema aphakia patient Jose, aged 87, undergoes surgery at the IRO (Regional Institute for Ophthalmology) on April 18, 2018 in Trujillo, Peru. Following a clinical screening day, Jose was chosen for a penetrating keratoplasty procedure (cornea transplant) during a programme run by Orbis, the ophthalmic training organisation. Founded in 1982 by ophthalmologist David Paton, Orbis trains eyecare teams across Africa, Asia and Latin America to improve the standard of eyecare in the region. As well as working in local hospitals, the charity also has a self-sufficient surgical unit on the Orbis Flying Eye Hospital, a converted McDonald-Douglas MD10 aircraft. (Photo by Leon Neal/Getty Images)
The treatment following penetrating keratoplasty for eyes with fungal keratitis resulted in reduced risk of recurrence.

Treatment with topical cyclosporine 0.1% after therapeutic penetrating keratoplasty (TPK) seems to increase graft survival and postoperative vision with reduced risk of recurrence of primary infection, according to a study published in Cornea.

In earlier research, investigators observed a high graft failure rate after TPK in eyes with fungal keratitis. Postoperative inflammation was one of the major reasons for graft failure in other eyes in the study. Investigators in the current study hypothesized that controlling the immediate postoperative inflammation with an agent that did not simultaneously promote fungal recurrence would increase the chance of graft survival.

Researchers launched a prospective case series to test the efficacy and safety of topical cyclosporine 0.1% in preventing early graft failure. The study included patients with fungal keratitis undergoing TPK between May and December 2019 treated with cyclosporine A 0.1% eye drops (tCSA group). They compared the outcomes with a historical cohort of patients treated conventionally with topical prednisolone acetate 1% eye drops started 3 weeks after surgery (CT group).

There were 20 patients (13 men) in the tCSA group and 28 patients (23 men) in the CT group. The number of clear grafts 3 months postoperatively was 10 (50%) in the tCSA group and 4 (14.3%) in the CT group (P =.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 =.003). There were 5 patients (17.9%) with recurrence of the primary fungal infection in the CT group, 4 of whom used topical prednisolone. There was no recurrence in the tCSA group. Analysis revealed higher odds of a clear graft at 3 months postoperatively with topical cyclosporine 0.1% (P =.004).

There were several limitations to this study, including the use of a historical cohort as a control group, a difference in the duration of preservation of the donor corneas, that the treatment group was smaller than the historical control group, and the early use of topical prednisolone.

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Reference

Chatterjee S, Agrawal D. Use of topical cyclosporine 0.1% in therapeutic penetrating keratoplasty for fungal keratitis. Cornea. Published online September 4, 2021. doi:10.1097/ICO.0000000000002827

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