Survey of Topical Steroid Usage Patterns After Descemet Membrane Endothelial Keratoplasty

To investigate global practice patterns of topical steroid treatment after Descemet Membrane Endothelial Keratoplasty (DMEK).

An anonymized electronic questionnaire was disseminated to KeraNet members in March 2024, exploring postoperative corticosteroid use in three scenarios: 1) post-DMEK for Fuchs endothelial corneal dystrophy (FECD), 2) post-DMEK for pseudophakic bullous keratopathy (PBK), and 3) postrepeat DMEK after previous graft failure.

Seventy-eight responses were obtained from ophthalmologists in 15 countries. Participants performed a median of 37.5 DMEKs per year (mean 45.8; SD 46.7; range 2-300). Prednisolone 1% was the preferred topical steroid during the 12 months post-DMEK for FECD, in the 24 months post-DMEK for PBK, and after 24 months postrepeat grafts. Thirty-four surgeons (44%) discontinued topical steroids at 24 months post-DMEK for FECD, whereas 41 (53%) continued steroid drops indefinitely. For PBK, 36% of surgeons ceased topical steroid use at 24 months; 54% continued indefinitely. In repeat DMEKs after previous graft failure, 63% reported indefinite topical steroid treatment. Variability was also noted in long-term follow-up regimens: 45% of surgeons discharge their patients between postoperative years 1 to 5. The remaining 55% of respondents opted for indefinite patient follow-up.

We identified significant variation in postoperative corticosteroid therapy after DMEK for FECD, PBK, and postgraft failure. This heterogeneity warrants further investigations exploring rates of graft rejection and failure across different postoperative steroid regimens. An international consensus would aid in standardizing postoperative care.