Specialist warns against discontinuing steroids after corneal transplantation

HYDERABAD, India — New lamellar techniques have reduced the risk of graft rejection after corneal transplantation, but low-dose steroid therapy should not be discontinued, particularly in patients with African ancestry, pre-existing glaucoma or steroid-induced ocular hypertension, according to a specialist.

“A paper published by W. Barry Lee in 2009 reported an average incidence of 10% with DSEK, and a large series published by M.O. Price in the same year estimated a graft rejection probability of 7.6% by 1 year and 12% by 2 years,” Rajesh Fogla, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Rajesh Fogla

However, the relative risk was shown in the second study to be five times higher for African Americans and two times higher for patients with pre-existing glaucoma and steroid-responsive ocular hypertension.

“In 2012, a study by J.Y. Li found a similar rejection rate of 7.3% with DSAEK, but the risk was observed to be higher at 2 years, after discontinuation of steroids,” Fogla said. “Another series published in the same year by Elaine L. Wu showed a rejection rate of 8.5%, with a 2.7-fold increase in patients with African ancestry. A 5.5-fold increase was also found after discontinuation of steroids.”

Significant improvements were shown with Descemet’s membrane endothelial keratoplasty, which was found to have a 1% rejection rate at 1 and 2 years in a study by F. Price.

Fogla recommended that steroid therapy always be continued indefinitely at a low dose, particularly in high-risk cases. With steroid responders, strict control of IOP and use of loteprednol should provide good control of side effects, he said.

Disclosure: Fogla has no relevant financial disclosures.