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DMEK graft rejection rate low with postoperative corticosteroids
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Descemet’s membrane endothelial keratoplasty yielded a low graft rejection rate at 1 year with high- and low-dose postoperative topical corticosteroids, according to study findings.
The prospective, randomized, open-label, controlled trial included 325 eyes that underwent Descemet’s membrane endothelial keratoplasty (DMEK); 297 eyes completed the study.
Patients used prednisolone acetate 1% four times daily for 1 month after DMEK and were then randomly assigned on a 1:1 ratio to use prednisolone acetate 1% or fluorometholone 0.1% from months 2 to 12.
The dosing frequency for both study groups was four times daily in months 2 and 3 after DMEK, three times daily in month 4, twice daily in month 5 and once daily in months 6 to 12. The researchers evaluated outcomes at 1, 3, 6 and 12 months postoperatively, defining elevated IOP as IOP of 24 mm Hg or higher or a 10 mm Hg increase from baseline.
Study results showed that no eyes in the prednisolone group and two eyes in the fluorometholone group had graft rejection. Both cases of rejection resolved with topical steroids.
Twenty-two percent of eyes in the prednisolone group and 6% of eyes in the fluorometholone group exceeded the defined IOP elevation threshold; the between-group difference was considered statistically significant, according to the researchers.
Glaucoma medications were initiated or increased in 17% of eyes in the prednisolone group and 5% of eyes in the fluorometholone group.
Endothelial cell loss was similar in both groups at 1 year, according to the researchers.
Disclosure: Price has received grants and consulting or lecture fees from Alcon, Allergan and Bausch + Lomb.
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