Tacrolimus dye drop treatment for the management of early post‑operative intraocular inflammation after therapeutic keratoplasty for severe infectious keratitis

Abstract

The current study investigated the anti-inflammatory effect of 0.1% tacrolimus eye drops for the treatment of therapeutic penetrating keratoplasty (TPK) for severe infectious keratitis during early disease stages and reported the long-term clinical outcomes. The present retrospective study included 20 eyes from patients diagnosed with severe keratitis who underwent TPK surgery. Patients were followed-up for up to 12-18 months. Tacrolimus eye drops were administered 4 times/day starting on the first day post-surgery. Glucocorticoid eye drops were subsequently added to treatment plans one-month post-surgery. All patients were followed-up for the first 3 post-operative days, then examined once a week thereafter for the first month. In early post-operative stages, the states of the grafts (ΔS) and the absorption of intraocular inflammation (S) were observed. ΔS was defined as the difference between the states of the grafts on the first post-operative day (SS1d) and those at one month post-surgery (SS1m). S was calculated as the difference between the inflammation score mean one day post-surgery (T1d) and the mean one-month post-surgery (T1m). For long term clinical outcomes, graft failure rates and complications were recorded. Among the 20 eyes analyzed, the mean T1d, T1m and S were 7.4±2.06, 2.0±2.47 and 5.4±2.13 (P<0.01), respectively. The mean SS1d, SS1m and ΔS were 5.3±1.56, 3.8±1.24 and 1.5±1.5 (P<0.01), respectively. During follow-up, there were 6 cases of corneal graft failure, 4 of which were due to immune rejection and 2 of which were due to complications. The current study concluded that tacrolimus eye drops facilitated the absorption of intraocular inflammation in the early post-operative period of TPK and may extend long term survival of grafts in cases of severe infectious keratitis.

A Pilot Study to Evaluate Genipin in Staphylococcus aureus and Pseudomonas aeruginosa Keratitis Models: Modulation of Pro-Inflammatory Cytokines and Matrix Metalloproteinases

“…An essential aspect of the pathogenesis of bacterial keratitis is the host’s inflammatory response, as uncontrollable and persistent infiltration of inflammatory cells may lead to delayed corneal wound healing, corneal opacity, and even result in corneal perforation, and vision loss. Although corneal transplantation is highly successful in low-risk cases, in the context of an inflamed eye, it has little success rate [ 5 , 70 , 71 ]. The dramatic increase in multidrug-resistant microbes is an additional challenge in managing the disease using antimicrobials, further emphasizing the urgent need for new therapeutic approaches for keratitis [ 72 ].…”

Advances in corneal graft rejection

“…In another study published in 2021, topical 0.03% tacrolimus was found to be as effective as systemic mycophenolate mofetil as adjuncts to topical and systemic corticosteroids in reducing endothelial graft rejection with 12 months follow-up after repeat keratoplasty [44]. Lastly, in a cohort of 20 very high-risk therapeutic PKP for severe infectious keratitis, 0.1% tacrolimus eye drops were found to facilitate the reduction of intraocular inflammation in early postoperative period and may extend long-term survival of grafts in cases of severe infectious keratitis [45].…”

Post-Keratoplasty Microbial Keratitis in the Era of Lamellar Transplants—A Comprehensive Review

“…First of all, other immunosuppressive specimens have been widely studied, starting with cyclosporin 0.1% which has proven efficacy as a post-keratoplasty anti-inflammatory treatment [71]. Another one, tacrolimus, the second calcineurin inhibitor with a lower potential for impeding corneal epithelium, has been explored [72].…”