Use of Topical Cyclosporine 0.1% in Therapeutic Penetrating Keratoplasty for Fungal Keratitis

Abstract

The efficacy and safety of topical cyclosporine 0.1% in preventing early graft failure after therapeutic penetrating keratoplasty (TPK) in eyes with fungal keratitis were evaluated.Methods: This prospective case series included patients with fungal keratitis undergoing TPK from May to December 2019 who were treated with cyclosporine A 0.1% eye drops (tCSA group). We compared the outcome with a historical cohort of patients who were treated conventionally (CT group) with topical prednisolone acetate 1% eye drops started 3 weeks after surgery.Results: There were 20 patients (male: 13; female: 7) in the tCSA group and 28 patients in the CT group (male: 23; female: 5). The number of clear grafts 3 months postoperatively was 10 (50%) in the tCSA group and 4 (14.3%) in the CT group (P = 0.011). The mean logarithm of the minimum angle of resolution best-corrected visual acuity was 1.49 6 0.74 in the tCSA group and 2.10 6 0.62 in the CT group (P = 0.003). There were 5 patients (17.9%) with recurrence of the primary fungal infection in the CT group, 4 of whom were using topical prednisolone. There was no recurrence in the tCSA group. A logistic regression analysis revealed higher odds of a clear graft at 3 months postoperatively with topical cyclosporine 0.1% [odds ratio: 14.35 (95% confidence interval, 2.38-86.5), P = 0.004].Conclusions: Postoperative treatment with topical cyclosporine 0.1% seems to increase graft survival and postoperative vision with reduced risk of recurrence of primary infection in eyes with fungal keratitis undergoing TPK.

Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia

“…However, its use can potentiate and exacerbate the progression of fungal infections; hence, it must not be commenced until a causative agent is found and/or the patient has shown a favourable response to antibiotic/antifungal therapy [6,51]. An alternative treatment to control inflammation associated with fungal keratitis is topical cyclosporin, a calcineurin inhibitor and antifungal metabolite with antifungal properties [52]. It has been validated in the use of increasing corneal graft survival post penetrating keratoplasty for fungal keratitis as well as being synergistically combined with azole agents in treating resistant fungi [52,53].…”

Fusarium Keratitis—Review of Current Treatment Possibilities

“…This is currently the most common approach. We found promising results of using topical 0.5% and 0.1% cyclosporin A (CsA) instead of steroids in early postoperative treatment after TPK in fungal keratitis [ 140 , 141 ]. In some studies, the combination of azoles with CsA showed synergistic fungicidal effect [ 142 , 143 ].…”

Steroids in the Management of Infectious Keratitis

“…26 However, human studies of calcineurin inhibitors for fungal keratitis are limited. 27 The role of corticosteroids after therapeutic penetrating keratoplasty for fungal keratitis is unclear because steroids may help prevent immune rejection but may also increase the risk of recurrent infection. Several reports advocate withholding steroids for 1 to 2 weeks after surgery and only instituting steroid treatment if no signs of recurrent infection have developed during that period.…”