Study: No benefit from long-term topical steroids on post-PK endothelial cell loss

Long-term treatment with a topical steroid does not preserve endothelial cell density any better than short-term treatment after penetrating keratoplasty in normal-risk patients, a study found. "Our results may indicate that the etiology of chronic endothelial cell loss is not of inflammatory origin. Further studies are needed to investigate this phenomenon," the study authors said.

Nhung Xuan Nguyen, MD, PhD, of the University of Erlangen-Nürnberg in Germany, and colleagues compared the effects of short- and long-term topical steroid use on endothelial cell counts in 305 eyes of 305 patients.

After undergoing penetrating keratoplasty, all patients initially received prednisolone acetate 1% eye drops five times daily, which was slowly tapered over the first 6 months. The researchers then randomly assigned patients to either a short-term treatment group, which ceased steroid treatment, or a long-term treatment group, which continued receiving the drops once daily for an additional 12 months, according to the study authors.

Both groups experienced significant declines in endothelial cell densities postoperatively. At 6 weeks follow-up, cell densities averaged 1,941 cells/mm² in the short-term treatment group and 1,957 cells/mm² in the long-term treatment group. By 2 years follow-up, cell densities had significantly decreased to an average of 1,535 cells/mm² for the short-term treatment group and to 1,472 cells/mm² for the long-term treatment group (P < .001), according to the study.

Using a linear regression model, the researchers found that the short-term treatment group had an average endothelial cell density loss of 216 cells/mm² per year, which did not significantly differ from the average yearly loss of 206 cells/mm² in the long-term treatment group (P = .5), the authors noted.

The study is published in the March issue of Acta Ophthalmologica Scandinavica.