Abstract
Purpose :
To quantify steroid response in participants receiving topical steroids after Descemet membrane endothelial keratoplasty (DMEK).
Methods :
This secondary analysis of prospective cohort studies included participants undergoing DMEK with and without cataract surgery for Fuchs’ dystrophy. Participants with type 1 diabetes, glaucoma, connective tissue disease or previous ocular surgery except for uncomplicated cataract surgery were not included. All participants received optical and morphological assessment of disease severity and intraocular pressure (IOP) measurements before surgery and at least at one post-operative visit. Topical dexamethasone was administered four times per day and tapered monthly to one time per day. Steroid response was graded as no response, moderate (IOP 20-31 mmHg or increase of 6-15 mmHg) or high (IOP >31mmHg or increase >15mmHg) compared to median pre-operative IOP.
Results :
172 eyes of 132 participants with a median age of 68 years (interquartile range [IQR], 61-75) were included. 137 eyes (80%) underwent DMEK with cataract surgery and 35 eyes (20%) underwent DMEK only. Before DMEK median IOP was 14 mmHg (IQR, 12-16). At a median 12.6 months after DMEK (IQR, 10.7-14.4), 35 participants (27%) were moderate and 4 (3%) were high steroid responders. Maximum IOP was 15 mmHg (median; IQR, 13-17) for non-responders, 21 mmHg (IQR, 20-23) for moderate responders and 39 mmHg (IQR, 33-53) for high responders. Median increase was 2 mmHg (IQR, 0-3) for non-responders, 7 mmHg (IQR, 4.5-8.5) for moderate responders and 22 mmHg (IQR, 15-37) for high responders. IOP measurements met the criteria of steroid response after 4.6 months after DMEK (median; IQR, 0.9-11.9). During follow up, 4 (100%) high responders and 6 (17%) moderate responders were identified by the attending physician. There was no difference in steroid response between patients undergoing DMEK with and without cataract surgery.
Conclusions :
Every fifth DMEK patient had an increase in IOP associated with topical steroid therapy when compared to baseline. While steroid response was mostly moderate, less than 20% were detected in clinical practice. Determining baseline IOP before surgeries with known postoperative steroid regimens might help to identify steroid response and to prevent potential long-term complications.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.