Pan Am J Ophthalmol 2014, 13:93 (1 July 2014)
Corneal graft rejection is the most frequent cause for graft failure after penetrating keratoplasty (PK), an area in which we can improve by better prevention and management strategies. Corticosteroids remain the mainstay for both prevention and treatment of rejection; there seems to be a benefit of long-term topical steroids as prophylaxis and the use of pulsed IV steroids in the treatment of rejection itself. It is difficult to determine the role of other immunosuppressant's, but cyclosporine A, mycophenolate mofetil and tacrolimus are frequently used with good results in some studies. There is a need for well-designed randomized clinical trials to really evaluate the therapeutic benefit of these medications and new approaches on the pipeline.