Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery

详细信息    查看全文

• 作者：Robert Hoerster^a ; ^{r.hoerster@me.com" class="auth_mail" title="E-mail the corresponding author} ; ^{robert.hoerster@uk-koeln.de" class="auth_mail" title="E-mail the corresponding author}Author Vitae ; Tisha Prabriputaloong Stanzel^a ; Bjoern Olov Bachmann^a ; Sebastian Siebelmann^a ; Moritz Felsch^b ; Claus Cursiefen^aAuthor Vitae
• 刊名：American Journal of Ophthalmology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：163
• 期：Complete
• 页码：174-179.e2
• 全文大小：1831 K

文摘

To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME).

Design

Single-center comparative clinical study with historical controls.

Methods

Setting: Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year. Patients: Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. Inclusion Criterion: Triple-DMEK surgery. Exclusion Criteria: Prior retinal surgery, history of prior CME. Interventions: Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral-domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery. Main Outcome Measure: Development of CME detected by macular SD OCT during 6 months postoperatively.

Results

Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently (P = .003). Apart from the topical steroids during the first week, medical treatment was identical in both groups.

Conclusions

Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery.