Evaluation of the Efficacy of 2% Cyclosporine in Preventing Graft Rejection

Inclusion Criteria: * FOR ARM 1 Age greater than 18 years Vision more than 6/60 in the fellow eye. No prior keratoplasty Not more than 1 quadrant of corneal vascularisation No peripheral anterior synechiae. No active ocular surface disease (VKC, dry eye,) Uncontrolled uveitis or glaucoma No limbal stem cell failure. No Prior h/o HSV Primarily patients with dystrophies, degenerations and pseudophakic bullous keratopathy and non vascularised non herpetic corneal scars will be enrolled ARM 2: Inclusion criteria as above \& Those patients with medically unresponsive keratitis with no limbal involvement and in whom the graft size can be restricted to less than 9mm will be included in the study. This is to ensure that postoperative issues such as synechiae, recurrence of infection and uncontrolled glaucoma do not affect the study. Grafts must also be clear at the end of one month after surgery for patients to continue in the study.. Expected Outcome 1. Incidence of graft rejection in both arms. 2. secondary outcome Recovery from graft rejection in both arms. 3. Secondary outcomes- incidence of glaucoma and cataract. 4. secondary outcome Incidence of graft rejection in patients maintained only on cyclosporine after 1year. 5. It is expected that patients receiving cyclosporine will have a lesser incidence of graft rejection and exhibit faster recovery. The efficacy of long term prophylaxis of only cyclosporine in preventing graft rejection will also be evaluated. Exclusion Criteria:Any condition that would increase the risk of non-rejection graft failure such as Stevens-Johnson syndrome, xerophthalmia or severe exposure keratitis. Schirmer's test ≤ 5 mm in 1 minute Clinical evidence of limbal stem cell deficiency History of or active herpes simplex virus keratitis or other acute corneal infection \-