¹Flinders Drive, Bedford Park, South Australia, Australia

Correspondence: DJ Coster, Flinders Drive, Bedford Park 5042, South Australia, Australia. Tel: +61 8 8204 5511; Fax: +61 8 8204 5450; E-mail: doug.coster@flinders.edu.au

Received 28 February 2003; Accepted 28 February 2003.

Abstract

Corneal transplantation is not invariably successful despite the anterior chamber of the eye being an immunologically privileged site. Inflammation erodes privilege. Other than by reducing inflammation through meticulous surgery, careful postoperative surveillance, and effective topical corticosteroids in the postoperative phase, there is little that a surgeon can do to improve the outlook for the majority of patients receiving corneal transplants. For patients at appreciable risk, HLA Class I matching may help where it is available. So too will systemic immunosuppression where it can be justified. Despite these measures, the results of corneal transplantation have not shown the improvement seen in solid organ transplantation over the last 30 years. New approaches applicable to corneal transplantation are required.