Survey of steroid usage patterns during and after low-risk penetrating keratoplasty.
OBJECTIVE
To evaluate corneal surgeons' corticosteroid use to prevent rejection of routine first-time penetrating keratoplasty (PKP).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Price
Francis W
FW
Price Vision Group, Indianapolis, Indiana, USA. mprice@cornea.org
Price
David A
DA
Ngakeng
Vanessa
V
Price
Marianne O
MO
D000284:Administration, Oral; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D001035:Aphakia / Q000150:complications; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D006084:Graft Rejection / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections; D007432:Intraoperative Period; D015948:Keratoplasty, Penetrating; D011184:Postoperative Period; D019591:Pseudophakia / Q000150:complications; D018570:Risk Assessment
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents