Cyclosporine A Drug-Delivery System for High-risk Keratoplasty

      We read the article by Shi et al
      • Shi W.
      • Chen M.
      • Xie L.
      • et al.
      A novel cyclosporine a drug-delivery system for prevention of human corneal rejection after high-risk keratoplasty: a clinical study.
      reporting the efficacy of a novel cyclosporine (CsA) drug delivery system (DDS) for suppressing the occurrence of rejection and improving the survival of corneal allografts after high-risk keratoplasty with great interest. In this noncomparative case series consisting of 92 patients (92 eyes), the researchers demonstrated that the CsA DDS implanted in the anterior chamber was effective for the prophylaxis of immune rejection after high-risk keratoplasty. Furthermore, this DDS functioned without toxicity to the cornea and the iris of the patients. It can also decrease the rejection episode and prolong the survival time of allografts. We applaud the authors' efforts to develop a promising DDS for the treatment or prevention of graft rejection in high-risk keratoplasty, and their findings of the considerable efficacy and safety of this DDS are encouraging. However, several important concerns have not been addressed in this paper.
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      References

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      Linked Article

      • A Novel Cyclosporine A Drug-Delivery System for Prevention of Human Corneal Rejection after High-risk Keratoplasty: A Clinical Study
        OphthalmologyVol. 120Issue 4
        • In Brief
          To evaluate the efficacy of a novel cyclosporine A (CsA) drug-delivery system (DDS) in the anterior chamber for suppressing the occurrence of rejection and improving the survival of corneal allografts after high-risk keratoplasty.
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      • Author reply
        OphthalmologyVol. 120Issue 9
        • In Brief
          We would like to thank Hong et al for their comments regarding our recent publication. The intraocular safety evaluation after cyclosporine (CsA) drug delivery system (DDS) implantation was described in detail in the article. Complicated cataract was not specifically mentioned because it was not observed during the follow-up period. In our previous report,1 CsA DDS contained 1 mg of CsA, and the subsequent drug concentration in the aqueous humor was 10 ng/ml, with no complicated cataract. The safety of CsA DDS to the lens was associated with the extremely low CsA level, which did no harm to the biologic properties of the lens, as well as the appropriate site of DDS embedded in the inferior chamber angle, which gave CsA DDS no chance to move freely or contact with the lens surface, even if the patient head moved.
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