Corneal transplants may be the final step in restoring clear vision to many people with eye disorders.

Each year, over 80,000 corneal transplants are performed in the United States, with over 184,000 corneal transplant surgeries conducted worldwide. However, rejection rates for corneal grafts can be as high as 10%.

This is largely due to poor patient compliance with the medications, which require frequent administrations of topical eyedrops over a long period of time.

This becomes especially acute when patients show signs of early rejection of the transplanted corneas. When this occurs, patients need to apply topical eyedrops hourly to rescue the corneal grafts from failure.

The tedious process of eyedrop dosing causes a tremendous burden for patients. The resulting noncompliance to medication treatment can lead to even higher graft rejection rates.

Research led by a team at Virginia Commonwealth University may make the corneal grafts more successful by using nanoparticles to encapsulate the medication.

The novel approach could significantly improve patient compliance, according to a paper recently published in Science Advances, "Six-month effective treatment of corneal graft rejection."

Each nanoparticle encapsulates a drug called dexamethasone sodium phosphate, one of the most commonly used corticosteroids for various ocular diseases treatment such as ocular inflammation, non-infectious uveitis, macular oedema and corneal neovascularisation.

By using the nanoparticles to control the release of the medicine over time, patients would require only one injection right after the corneal transplantation surgery without frequent eye drops. Our studies have shown that using this method the medication maintains its efficacy for six months on a corneal graft rejection model.

In addition, because the medicine is released slowly and directly where it is most needed, the approach requires much lower doses than current standard eyedrop treatment while providing better efficacy and safety profiles.

Qingguo Xu, D.Phil., the principal investigator of this project and an associate professor of pharmaceutics and ophthalmology at VCU School of Pharmacy, collaborated with Justin Hanes, Ph.D., the Lewis J. Ort professor of ophthalmology at Johns Hopkins University.

Tuo Meng, Ph.D., who worked on the project as a doctoral student at VCU and is the first author of this paper, said: "In our preclinical corneal graft rejection model, the single dosing of the nanoparticle successfully prevented corneal graft rejection for six months."

More importantly, the nanoparticle approach reversed signs of early rejection and maintained corneal grafts for six months without rejection. Xu's lab focuses on developing nanotherapeutics for safer and more effective treatment of various eye diseases.