In a study of three groups of high-risk keratoplasty patients, Group A (n = 19) received topical corticosteroids only; two grafts (10.5%) survived. Group B (n = 20) received both topical and systemic corticosteroids; one graft (5%) survived. There was no significant difference between Group A and Group B (P = .8095). Group C (n = 18) received systemic cyclosporine in addition to topical and systemic corticosteroids; 16 grafts (88.9%) survived, which was a significant improvement compared to results in the other two groups (P = .0001). No patient suffered any permanent side effects related to the use of cyclosporine.