Up-to-date opportunities for the therapy of tissue incompatibility after keratoplasty
Trufanov S.V., Subbot A.M., Malozhen S.A., Krakhmaleva D.A.

Research Institute of Eye Diseases, Moscow

Because of the immune privileged position of the cornea, keratoplasty is the most successful operation in transplantology. One of the main reasons for the unsuccessful outcome of the corneal transplantation is tissue incompatibility, which can be increased several times by risk factors and can reach 70%.
Timely administration and the right choice of immunosuppression therapy is crucial for the corneal transplantation outcome, especially in the high-risk group. This category of patients needs an intensive therapy by immunosuppressive drugs.
The review analyzes modern immunosuppressants used in ophthalmic practice and those undergoing the clinical trials. Corticosteroids, calcineurin inhibitors and antimetabolites, are the most widely used in clinical practice, but they are not always effective. In addition, their use can be limited because of high toxicity.
In recent years, transplantology has been searching for the new selective methods for preventing and suppressing the immune responses by means of phylogenetically pre-existing mechanisms of induction of antigen-specific tolerance in the recipient organism, capable of ensuring the long-term and qualitative survival of organ and tissue grafts. The effectiveness of their use in clinical practice has yet to be evaluated.

Key words: keratoplasty, corneal graft rejection, immune privilege, immunosuppression, corticosteroids, Ciclosporin A, Tacrolimus, Mycophenolate mofetil, VEGF inhibitors.
For citation: Trufanov S.V., Subbot A.M., Malozhen S.A., Krakhmaleva D.A. Up-to-date opportunities for the therapy of tissue incompatibility after keratoplasty // RMJ. Clinical ophthalmology. 2017. № 3. P. 175–179.