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Cyclosporine is a potent immunosuppressive agent that functions as a calcineurin inhibitor. This specific 2% topical ophthalmic formulation is being evaluated by the Aravind Eye Care System for the prevention of corneal graft rejection in patients undergoing penetrating keratoplasty (PKP) or therapeutic keratoplasty (TKP). By binding to intracellular cyclophilin A, cyclosporine forms a complex that inhibits the phosphatase activity of calcineurin. This inhibition blocks the translocation of the nuclear factor of activated T-cells (NFAT) and the subsequent transcription of pro-inflammatory cytokines, most notably interleukin-2 (IL-2). By preventing T-cell activation and proliferation, the drug aims to mitigate the host immune response against donor corneal tissue, particularly in high-risk or therapeutic graft scenarios where standard steroid therapy alone may be insufficient.
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