1;Foreword;6 2;Preface;7 3;Contents;8 4;Contributors;14 5;Chapter 1;16 5.1;Immune Privilege of Corneal Allografts;16 5.1.1;1.1 History of Corneal Transplantation and Immune Privilege;16 5.1.2;1.2 How Successful Is Corneal Transplantation?;17 5.1.3;1.3 Immune Rejection of Corneal Allografts;18 5.1.3.1;1.3.1 Role of CD4+ T Lymphocytes in Corneal Allograft Rejection;18 5.1.3.2;1.3.2 Role of CD8+ T Lymphocytes in Corneal Allograft Rejection;18 5.1.3.3;1.3.3 Role of Antibodies in Corneal Allograft Rejection;19 5.1.3.4;1.3.4 Role of Macrophages and NK Cells in Corneal Allograft Rejection;19 5.1.3.5;1.3.5 What are the Eff ectors of Corneal Allograft Rejection?;20 5.1.4;1.4 Role of Atopic Diseases in Corneal Allograft Rejection;20 5.1.5;1.5 Immune Privilege of Corneal Allografts Is a Tripartite Phenomenon;20 5.1.5.1;1.5.1 Aff erent Blockade of the Immune Response to Corneal Allografts;21 5.1.5.2;1.5.2 Immune Deviation in the Central Processing Component of the Immune Reflex Arc;23 5.1.5.3;1.5.3 Eff erent Blockade of the Immune Response to Corneal Allografts;24 5.1.6;References;25 6;Chapter 2;28 6.1;Mechanisms of Corneal Allograft Rejection and the Development of New Therapies;28 6.1.1;2.1 Status of Corneal Transplantation;28 6.1.2;2.2 Success Rate of Corneal Transplantation;28 6.1.3;2.3 Maintenance and Erosion of Corneal Privilege;29 6.1.4;2.4 The Corneal Allograft Response;30 6.1.5;2.5 Antigen Uptake in the Eye;30 6.1.6;2.6 Antigen Processing;31 6.1.7;2.7 Antigen Presentation;31 6.1.8;2.8 T Cell Activation, Proliferation, and Clonal Expansion;32 6.1.9;2.9 Eff ector Arm of the Allograft Response;32 6.1.10;2.10 Current Management of Corneal Transplants;32 6.1.11;2.11 Prevention of Allograft Rejection;32 6.1.12;2.12 Stratifi cation of Risk;33 6.1.13;2.13 Protecting Immune Privilege;33 6.1.14;2.14 Minimizing Antigenic Diff erences Between Donor and Recipient;33 6.1.15;2.15 Systemic Immunosuppression;33 6.1.16;2.16 Surgical Techniques and Postoperative Management;33 6.1.17;2.17 Management of Acute Rejection Episodes;34 6.1.18;2.18 New Therapies with Novel Mechanisms;34 6.1.19;2.19 Antibody-based Immunosuppressive Agents in Transplantation;34 6.1.20;2.20 Engineered Antibodies for Eye Disease;34 6.1.21;2.21 Gene Therapy of the Donor Cornea;35 6.1.22;2.22 Vectors for Gene Therapy of the Cornea;35 6.1.23;2.23 Transgenes for Prolonging Corneal Graft Survival;35 6.1.24;2.24 Future Prospects;35 6.1.25;References;37 7;Chapter 3;39 7.1;New Developments in Topical and Systemic Immunomodulation Following Penetrating Keratoplasty;39 7.1.1;3.1 Introduction;39 7.1.2;3.2 Immunology;40 7.1.2.1;3.2.1 Acute Rejection;40 7.1.2.2;3.2.2 Major Histocompatibility Complex (MHC);40 7.1.2.2.1;3.2.2.1 Direct Pathway of Allorecognition;40 7.1.2.2.2;3.2.2.2 Indirect Pathway of Allorecognition;40 7.1.2.2.3;3.2.3 Chronic Rejection;40 7.1.3;3.3 Normal-risk vs. High-risk Transplantation;41 7.1.3.1;3.3.1 Normal-risk Transplantation;41 7.1.3.2;3.3.2 High-risk Transplantation;41 7.1.3.3;3.3.3 Rationale for Systemic Immunosuppression;41 7.1.3.4;3.3.4 Why Is Immunomodulation with Topical Steroids Not Suffi cient to Prevent Immunologic Graft Rejection in High-Risk Patients?;41 7.1.3.5;3.3.5 Rationale for Topical Immunomodulation;41 7.1.4;3.4 Immunosuppressive Agents;42 7.1.4.1;3.4.1 History;42 7.1.4.2;3.4.2 Corticosteroids;42 7.1.4.3;3.4.3 Cyclosporine A;42 7.1.4.3.1;3.4.3.1 CSA in Corneal Transplantation;43 7.1.4.4;3.4.4 Tacrolimus (fk506);43 7.1.4.4.1;3.4.4.1 Tacrolimus in Corneal Transplantation;43 7.1.4.5;3.4.5 Mycophenolate Mofetil (MMF);43 7.1.4.5.1;MMF in Corneal Transplantation;44 7.1.4.6;3.4.6 Rapamycin (Sirolimus);44 7.1.4.7;3.4.7 RAD (Everolimus);44 7.1.4.8;3.4.8 FTY 720;45 7.1.4.9;3.4.9 FK788;45 7.1.5;3.5 Pimecrolimus;45 7.1.5.1;3.5.1 Pimecrolimus in Corneal Transplantation;45 7.1.5.2;3.5.2 Biologic Agents;45 7.1.5.2.1;3.5.2.1 Basiliximab and Daclizumab;45 7.1.6;3.6 Guidelines for Practitioners;46 7.1.6.1;3.6.1 Systemic Immunosuppression with Drugs with Proven Effi