Prolonged topical steroid use may prevent graft rejection after PK

Extended use of corticosteroid eye drops prevented graft rejection after penetrating keratoplasty, a study found.

“Because no adverse consequences associated with the use of the eye drops were noted, we recommend continuing the use of low-dose corticosteroids, even in non–high-risk cases,” the study authors said.

The prospective, randomized clinical trial included 42 patients with a mean age of 65.3 years who underwent PK and had sustained graft clarity for more than 1 year with topical steroids.

Twenty-two patients were randomly assigned to receive 0.1% fluorometholone drops three times daily, and 20 patients discontinued drops. All patients were followed up for 12 months.

Snellen best corrected visual acuity, IOP, tear film breakup time, corneal epithelial damage and endothelial cell density were evaluated at study enrollment and at 1, 3, 6 and 12 months after the study began.

The mean interval from PK to initiation of the study was 38 months.

Study results showed that one patient in the steroid group and six patients in the no-steroid group experienced endothelial rejection an average of 5.2 months after enrollment. All eyes sustained graft clarity for the duration of the study.

The steroid group had a significant reduction in endothelial cell density between enrollment and 12-month follow-up (P = .0028). However, the steroid and no-steroid groups had similar endothelial cell density at 12 months.

The between-group difference in incidence of rejection was statistically significant based on chi-square analysis (P = .027) and Kaplan-Meier analysis (P = .032). Both groups had similar BCVA, IOP, epithelial damage, tear film breakup time, cataract development, infection and systemic side effects at 12 months, the authors said.

Published by:

Sources/Disclosures

Collapse

Source:

Ophthalmology. 2012;119(4):668-673.