topical cyclosporine a 2% in management of endothelial corneal allograft rejection

purpose: to determine whether adding 2% topical cyclosporine (csa) to local and systemic steroids in treatment of endothelial corneal allograft rejection improves the outcome. methods: a prospective randomized treatment trial was carried out on 40 consecutive corneal graft recipients, presenting with the first episode of endothelial graft rejection in two groups. group one (20 patients) received topical steroid eye drops and oral prednisolone (1 mg/kg). group two (20 patients) received the same topical and systemic therapy plus 2% cyclosporine eye drops. the patients were followed up for three months and their clinical outcomes were evaluated by the rates and time for reversal of rejection. results: in group one, 14 (70%) cases had total reversal of graft rejection episode  which started within a mean period of three days, but in the csa group, it occurred in 18 (90%) cases which started within a mean period of 1.5 days (p=0.21). among patients who sought treatment early (< 6 days), survival rates were 85% and 100%, respectively (p=0.2). in high risk patients, the rejection reversal rate was 66% in csa group and 25% in the control group (p=0.5). conclusion: addition of 2% csa eye drop to topical and systemic steroids may improve the rates of graft rejection reversal. it may also decrease the interval between initiation of treatment and improvement of clinical signs.