Incidence of Ultrathin Descemet Stripping Endothelial Keratoplasty Corneal Graft Rejection following Steroid Discontinuation

ABSTRACT

Purpose/Aims: To determine the incidence of corneal graft rejection in patients with approximately 1 year of steroid therapy following uDSEK. A shortened course of corticosteroids may be beneficial and a viable option in Ultrathin Descemet’s Stripping Endothelial Keratoplasty (uDSEK).

Materials and Methods: This retrospective cohort study evaluated corneal graft rejection rate in 170 cases of uDSEK that met inclusion criteria with approximately 1 year of steroid therapy. Corneal graft rejection was defined by anterior chamber cell/flare, keratic precipitates with/without corneal edema, and/or a rejection line. The following were collected retrospectively from January 1, 2005 through January 1, 2013: gender, age, race, indication for uDSEK, length of follow-up, length of steroid therapy. Continuous data were compared using Wilcoxon Rank Sum Test and categorical data were compared using Fisher’s Exact Test.

Results: The included eyes had an average length of steroid therapy of 431 days (range 85–720 days) with an average follow-up of 1274 days (range 395–3186 days). During the follow-up period without steroid, 5 of the 170 eyes were diagnosed with rejection (2.94%). Of the five eyes that experienced rejection, four eyes resolved after topical prednisone was reinstituted alone and did not require repeat uDSEK. The other eye was lost to follow-up. The cumulative probability of rejection after steroid cessation was calculated at 0.67% after 12 months, 2.20% after 18 months, 3.08% after 24 months, and 4.55% after 36 months.

Conclusion: Discontinuation of topical steroid at approximately 1 year after uDSEK results in a low rate of corneal graft rejection and may prove extended use unnecessary.

KEYWORDS:

• Descemet stripping endothelial keratoplasty
• corneal graft rejection
• cornea
• steroid
• dystrophy

Acknowledgments

We thank the Department of Ophthalmology, Wake Forest University School of Medicine for support.

Conflicts of interest

Dr. Keith Walter is a consultant and speaker for CorneaGen and he receives royalties for the EndoSerter. The authors report no other conflicts of interest.

This manuscript has not been accepted for publication elsewhere, is not being considered for publication elsewhere, and does not duplicate material already published. I confirm all authors consent to publication of this Work and that all authors have contributed significantly and are in agreement with the content of the manuscript.