High-risk penetrating keratoplasty

• Main Authors: Shilpa Ajit Joshi, Madan Deshpande
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2016-01-01
• Series: Journal of Clinical Ophthalmology and Research
• Subjects: Graft rejection; immunologically high-risk keratoplasties; pre-; intra-; and post-operative management; systemic immunosuppression
• Online Access: http://www.jcor.in/article.asp?issn=2320-3897;year=2016;volume=4;issue=3;spage=163;epage=170;aulast=Joshi

Background: Loss of immune privilege has important connotations for graft survival, often in clinical scenarios where the other eye is irreversibly blind. This article looks at the state of the evidence-based treatment available for high-risk penetrating keratoplasty (P.K.). Materials and Methods: Review of pathophysiological and immunological mechanisms present was done. Conclusion: Pre-, intra-, and post-operative considerations in P.K. in high-risk situation along with the role of immune-suppression are discussed. Success in high-risk keratoplasty depends on an ongoing effort during as well as life-long after P.K. The role of nonimmunological factors such as glaucoma, reactivation of infection, and unstable ocular surface are important determinants in graft failure.