To evaluate the safety and efficacy of tacrolimus eye drops as an adjuvant therapy in severe endothelial corneal graft rejection refractory to corticosteroids.

This prospective study included 11 eyes of 11 patients with severe endothelial graft rejection, who were refractory to intensive corticosteroids therapy despite adequate compliance with the therapy.All patients had received a combination of intensive topical, local and systemic steroids. The improvement in signs and symptoms of rejection and the development of complications was monitored

Improvement in the signs of rejection was noted in 10 out of 11 patients with complete response in 5 patients. Steroids could be successfully tapered in responsive cases without any recurrence in the follow up period. In one patient the recurrence of fungal keratitis was noted, otherwise except for mid to moderate burning and stinging upon drop instillation and superficial punctate keratopathy, no other complication was noted.

The results of this pilot study suggests that tacrolimus eye drops could be a promising option in patients presenting with severe endothelial corneal graft rejection refractory to corticosteroids.