1. ¹Department of Ophthalmology, Flinders University, Adelaide, Australia
2. ²Transplantation Immunology Laboratory, Queen Elizabeth Hospital, Adelaide, Australia
3. ³Department of Medicine, University of Adelaide, Adelaide, Australia

Correspondence: DJ Coster, Department of Ophthalmology, Flinders Medical Centre, Bedford Park, SA 5042, Australia. Tel: + 618 8204 4899; Fax: + 618 8277 0899; E-mail: doug.coster@flinders.edu.au

Received 11 December 2008; Accepted 11 December 2008; Published online 20 February 2009.

Abstract

Corneal transplantation has not matched the improvements in outcome seen with other clinical transplantation procedures. The therapeutic strategies, which have improved the outcomes of solid vascularised organs are not applicable to corneal transplantation. Corneal transplantation is different with respect to relevant transplantation biology and the clinical context in which it is practiced. New approaches need to be developed which provide regional rather than systemic immunosuppression. The accessibility of the cornea makes it particularly suitable for topical medication and for gene therapy approaches. Engineered antibodies, small enough to pass through the cornea, and directed at key molecules in the allograft response have been developed. Gene therapy had been developed using viral vectors to transfect the corneal endothelium with the genes for immunosuppressive lymphokines. Both approaches show promise.