Cyclosporine as postoperative immunomodulating agent in penetrating keratoplasty for keratomycosis: a case series

Purpose: This study evaluates the efficacy and safety of topical cyclosporine A (tCSA) 2% as an immediate postoperative immunosuppressant following penetrating keratoplasty (PKP) for fungal keratitis to reduce graft rejection and fungal recurrence. Methods: A retrospective case series at Duke Eye Center included six patients who underwent PKP for keratomycosis (2023–2024). Patients received tCSA 2% for at least one week before transitioning to topical prednisolone. Outcomes included graft rejection, fungal recurrence, visual acuity, and corneal clarity over six months. Results: Five distinct fungal pathogens were identified; no fungal recurrence or graft rejection occurred. Surgical outcomes were favorable, with tCSA treatment lasting 3–24 weeks, allowing for delay of prednisolone initiation. Conclusion: tCSA may help manage inflammation while minimizing fungal recurrence, serving as a bridge to corticosteroids. These findings support its potential role in postoperative PKP care, warranting further research for standardized protocols.