{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:22:23Z","timestamp":1787840543561,"version":"build-2784847793"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the use of topical tacrolimus as an adjunct therapy to corticosteroids in preventing graft rejection in high-risk penetrating keratoplasty (PKP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A comprehensive search was conducted through PubMed\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , EMBASE\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , Cochrane Central Register of Controlled Trials, and Google Scholar\n                      <jats:sup>\u00ae<\/jats:sup>\n                      databases from 2000 to 2023. Eligible studies included meta-analysis, systematic review, clinical trial, and case presentations that compared graft rejection rates in high-risk PKP patients treated with corticosteroid versus corticosteroid plus tacrolimus. Studies with a control group using noncorticosteroid therapy were excluded from the study. The study selection process followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using Cochrane Risk of Bias 2.0 (RoB 2.0), Newcastle\u2013Ottawa Scale, and RoB for Nonrandomized Intervention Studies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Five studies comprising 298 eyes were included in the study. Rejection rates were found significantly lower in the tacrolimus group (RR: 0.63; 95% confidence interval [CI]: 0.46\u20130.88;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.006). Tacrolimus also significantly reduced irreversible rejection (RR: 0.50; 95% CI: 0.27\u20130.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03) and improved visual acuity (RR: 1.45; 95% CI: 1.08\u20131.93;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Tacrolimus successfully reduces the rejection rate and irreversible rejection in high-risk PKP patients. Improved visual acuity was observed. There were no significant side effects; however, further studies are still needed to achieve more quantitative results, like recommended concentrations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joco.joco_75_25","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T09:02:59Z","timestamp":1773824579000},"page":"271-283","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The Use of Topical Tacrolimus as Adjunct Therapy to Corticosteroid in a High-Risk Penetrating Keratoplasty: A Systematic Review and Meta-Analysis"],"prefix":"10.4103","volume":"37","author":[{"given":"Muhammad Shafiq","family":"Advani","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, 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