Current practices in the prevention and treatment of corneal graft rejection

Three hundred fourteen members of the Castroviejo Society were surveyed to determine current practices in the prevention and treatment of corneal graft rejection. One hundred thirty-seven responses were received and tabulated for routine postoperative prophylactic immunosuppression as well as treatment of epithelial rejection, endothelial rejection (three patterns), subepithelial infiltrates, acutely and progressively opacifying grafts without inflammation, and photophobia. All respondents applied topical steroids in the postoperative period, while about half also administered steroids subconjunctivally. For the treatment of obvious endothelial rejection, 100% of respondents used topical steroids, 57% used subconjunctival steroids, and 37% used systemic steroids. Prednisolone acetate, 1%, was the preferred topical preparation for all conditions (55-68% of respondents). Individual responses to the questionnaire showed a surprisingly wide variation in treatment preferences.