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V. E. Ngakeng, M. Price, F. Price, Jr.; Steroid Management of Penetrating Keratoplasty What Is Standard?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2343.
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To answer the question on what the most current steroid regiment used by ophthalmic surgeons in routine PKP in phakic, pseudophakic and aphakic patients.
An endothelial keratoplasty and corneal surgery course is offered by Dr. Francis Price at the Price Vision Group a tertiary referral center in Indianapolis. Starting in March of 2006 all surgeons attendees were given a survey to determine current steroid practices after PKP. The questionnaire included 10 questions.
Over a 21 month period there was a total of 218 participants. All were surveyed and 218 returned a survey, a participation rate of 100%. 18 of those were not legible or incomplete and had to be removed from the pool. There was universal use of topical steroids in the post-operative period. 87% used Pred Forte® (prednisolone acetate ophthalmic suspension, USP, Allergan, Irvine, CA), the remainder used, FML® (fluorometholone, Allergan, Irvine, CA), Lotemax® (loteprednol etabonate ophthalmic suspension 0.5% New York Bausch & Lomb Rochester), Tobradex (tobramycin and dexamethasone ophthalmic suspension USP, Alcon, Fort Worth, Texas), Maxidex® (Dexamethasone), and Econopred® and Econopred® Plus (Prednisolone Acetate). Econopred being the second most prescribed drug. The first post-operative day 75% of surgeons prescribed their chosen steroid drop 4 times a day irrespective of the type of steroid, 15% prescribed the steroid every two hours, 6.5% 6 times a day, 5% 8 times a day and a smaller subset had more varied regiments at day one. At one month 70% of patients were using their drops 4 x a day, 5% were using drops either, eight, six or three times a day. Data analysis was completed at all time points from post day one to greater than a year. 54% used a topical steroid at least once a day forever as long as there were no contraindications. 81% did not use oral steroids, 15 % used no intraoperative steroids, while 85% used either subtenon’s, subconjunctival or intravenous steroids at the time of surgery. The regiments were the same in phakic, pseudophakic and aphakes except for 5% of surgeons who in the pseudophake and aphake group had the patient remain on steroid for ever versus stopping them at a year in their phakic group.
This is one of the largest survey documenting common practices of steroid use after PKP in pseudophakes, aphakes and phakic patients. It allows surgeons to look at their own practice and compare it to average. Unlike the other surveys this study allows follow-up of the different regiment at all time points after transplant. Moreover, it also shows that the majority of surgeons have similar prophylaxis patterns.
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