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EW CORNEA 45 May 2014 WELCOME TO THE ERA OF CENTURION ® Active Fluidics ™ Automatically optimizes chamber stability by allowing surgeons to customize and control IOP throughout the procedure. Balanced Energy ™ Enhances cataract emulsification efficiency using OZil ® Intelligent Phaco and the new INTREPID ® Balanced Tip design. Applied Integration ™ Designed to work seamlessly with other Alcon technologies for an integrated cataract procedure experience. Optimize every moment of your cataract removal procedure with the NEW CENTURION ® Vision System. ©2013 Novartis 8/13 CNT13017JAD Learn more about the new era of cataract procedures. Visit MyAlcon.com. For important safety information, please see adjacent page. Another issue would be to see if investigators could mimic first-time rejection in animals and then later come back with a matched trans- plant. "Can we mimic what might happen in the real world with pa- tients and ophthalmologists?" Dr. Niederkorn asked. The good news, he said, is they have established the principle and shown that it does work. "We can attain a survival rate that is just as good as with steroids, but we're just blocking with one simple molecule," Dr. Niederkorn said. Prolonged use of steroids can cause cataract and glaucoma, he went on, adding that this is not a risk here. This strategy instead in- volves a pinpoint immune response tied to T-regulatory cells. "They do what the name implies—they regu- late the immune response," Dr. Niederkorn said. He describes this as akin to a thermostat that works to keep the house from getting too hot. "If you exaggerate the T-regulatory response, you get the immune sys- tem completely shut off," he said. This can result in long-term trans- plant survival. When MHC matching is done in the presence of interferon gamma, T-regulatory cells are not generated, Dr. Niederkorn explained. But if interferon gamma is blocked in conjunction with matching, it allows for the full development of the T-regulatory cells. Overall, in cases where MHC matching is done in conjunction with suppression of interferon gamma, the T-regulatory cells can emerge and promote graft survival, Dr. Niederkorn said. "Unlike steroids or heavy-duty anti-rejection drugs, which suppress the immune system across the board, the T-regulatory cells are ideal because they only sup- press the immune response to the transplantation antigens," he said. "They preserve immunity to all other infectious agents and all other insults that the host would encounter." The result could be enhanced graft survival, even in otherwise high-risk cases, without contending with steroids, he concluded. EW Reference Cunnusamy K, Niederkorn JY. IFN-γ blocks CD4+CD25+ Tregs and abolishes immune privilege of minor histocompatibility mis- matched corneal allografts. Am J Transplant. 2013 Dec: 13(12):3076-84. Editors' note: Dr. Niederkorn has no related financial interests. Contact information Niederkorn: jerry.niederkorn@utsouthwestern.edu

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