Immunosuppressive therapy is the main postoperative treatment for
keratoplasty, but there are considerable differences in protocols for the use of
steroids and other
immunosuppressants. Therefore, we conducted 2 prospective randomized clinical trials and 1 prospective nonrandomized clinical trial on
keratoplasty postoperative treatment. One study evaluated the efficacy and safety of long-term topical
corticosteroids after a
penetrating keratoplasty was performed. Patients who underwent
keratoplasty and maintained graft clarity for >1 year were randomly assigned to either a
steroid or a no-
steroid group. At the 12-month follow-up, the no-
steroid group developed significantly more endothelial rejection than did the
steroid group. A second study elucidated the effectiveness and safety of systemic
cyclosporine in high-risk
corneal transplantation. The patients were assigned to a systemic
cyclosporine or control group. At a mean follow-up of 42.7 months, no difference was observed in the endothelial rejection rates and graft clarity loss between the 2 groups. A third study elucidated the effectiveness and the safety of systemic
tacrolimus in high-risk
corneal transplantation. Of 11 consecutive eyes decompensated despite systemic
cyclosporine treatment, there was no irreversible rejection in eyes treated with
tacrolimus, which was significantly better than in previous
penetrating keratoplasty with systemic
cyclosporine treatment. Prognosis after
keratoplasty in patients with
keratoconus is relatively good, but special attention is required for patients with
atopic dermatitis. Postkeratoplasty atopic sclerokeratitis (PKAS) is a severe form of sclerokeratitis after
keratoplasty in atopic patients. Our retrospective study showed that 35 eyes of 29 patients from a total of 247
keratoconus eyes undergoing
keratoplasty were associated with
atopic dermatitis, of which 6 eyes of 5 patients developed PKAS. Eyes with PKAS had a significantly higher incidence of atopic
blepharitis and preoperative
corneal neovascularization, and therefore, we suggest systemic
corticosteroids or
cyclosporine to prevent PKAS in such high-risk cases.