The success rate for uncomplicated penetrating keratoplasty is very hi
gh. However, in high risk patients there is a significantly increased
risk for immunologic graft failure and the success rate is relatively
poor. Oral cyclosporin A treatment has dramatically decreased the reje
ction rate in solid organ transplantation. Its oral use in ophthalmolo
gy has so far been relatively limited and topical use restricted by po
or penetration of the drug into ocular tissues. The favorable results
of oral cyclosporin treatment to prevent corneal graft failure in high
-risk patients is demonstrated in this study. High-risk corneal transp
lant patients were selected from the general population scheduled to u
ndergo corneal transplantation. Twenty-two of 277 patients who were op
erated during a four-year period were regarded as highrisk keratoplast
y patients, Systemic cyclosporin A treatment (5mg/kg/day) was given pr
ophylactically to 14 of these patients who were considered to be at hi
gh-risk for keratoplasty rejection (CsA group). In addition the patien
ts received a low dose of corticosteroids. Eight similar patients rece
iving high dose corticosteroids served as a control group (control gro
up). In the CsA group graft survival was 78.6% compared with 37.5% in
the control group at 1.5 years. The grafts of patients receiving CsA h
ad a significantly better survival rate (p<0.05) than those in control
at one and 1.5 years, On the follow-up to four years graft survival i
n patients treated with CsA was, however, decreasing to 35.7%. The low
graft survival in both high-risk groups is in great contrast to graft
survival in all patients operated during the same period (93.1%). Sys
temic cyclosporin treatment when received at the time of the operation
is effective in reducing failure from irreversible rejection in high-
risk keratoplasty, but for maximal effect, a six-month period of treat
ment is too short. Subjective side effects were frequent but still acc
eptable. Blood tests did not reveal any pathological hepatic or renal
laboratory values caused by systemic CsA administration. Careful and f
requently follow-ups of the patients are however needed.