Survey of steroid usage patterns during and after low-risk penetrating keratoplasty

To evaluate corneal surgeons' corticosteroid use to prevent rejection of routine first-time penetrating keratoplasty (PKP).

Between March 2006 and June 2008, corneal surgeons taking an endothelial keratoplasty course at Price Vision Group, a tertiary referral center in Indianapolis, Indiana, were surveyed about steroid usage patterns.

Of 271 attendees, 250 (92%) returned a survey. Regardless of lens status, 76% used intraoperative steroids. Dexamethasone was preferred by 72% of those who used injectable steroids. Everyone prescribed topical steroids, and 95% prescribed prednisolone acetate 1%. Most (57%) used the same regimen regardless of lens status. For phakic patients, median daily dosing was 4x for 2 months, 3x for month 3, 2x for month 4, and 1x until 1 year. For pseudophakic/aphakic patients, median daily dosing was the same, except 2x extended through month 5 and 1x continued beyond a year. Topical steroids were continued indefinitely by 46% in pseudophakic/aphakic patients and by 22% in phakic patients. Lower-strength steroids were used for taper by 20% in phakic patients and 16% in pseudophakic/aphakic patients.

While the range of topical steroid dosing after initial PKP was wide, the narrow interquartile range reflected commonly held opinions. The study results can provide a baseline for prospective studies of medications and dosing to prevent PKP rejection.