title: Prevention and treatment of corneal graft rejection: current practice patterns of the Cornea Society (2011).
abstract: OBJECTIVE
  To analyze current practice patterns in the prevention and treatment of corneal graft rejection for both penetrating keratoplasty (PK) and endothelial keratoplasty (EK) and to compare these patterns with previously reported practices.
  
  
  METHODS
  In 2011, an electronic survey was sent to 670 members of the Cornea Society worldwide addressing the routine postoperative management of corneal transplants at different time points, treatment of various manifestations of corneal graft rejection, and preferred surgical techniques.
  
  
  RESULTS
  A total of 204 of 670 surveys (30%) were returned and evaluated. All respondents used topical corticosteroids for routine postoperative management and treatment of endothelial graft rejection. Prednisolone was the topical steroid of choice in all clinical scenarios, similar to previous surveys from 1989 to 2004. Use of subconjunctival and systemic steroids increased for many scenarios of probable and definite graft rejection. Routine use of prednisolone decreased by approximately 10% from previous surveys, whereas difluprednate was used in 13% of high-risk eyes during the first 6 months. Dexamethasone, fluorometholone, and loteprednol use remained stable. Adjunctive topical cyclosporine use increased significantly for PK and EK. EK was the preferred technique for endothelial dysfunction, whereas PK and deep anterior lamellar keratoplasty were both used for keratoconus and anterior scars. Most respondents (75%) felt that graft rejection occurs more frequently after PK than after EK.
  
  
  CONCLUSIONS
  Prednisolone remains the treatment of choice for management and treatment of graft rejection; however, since the introduction of difluprednate, its use has declined slightly since the introduction of difluprednate. Despite perceived differences in rejection rates, there were no differences in prophylactic steroid treatment for PK and EK.
authors: *Department of Ophthalmology, Emory University, Atlanta, GA; and †Stulting Research Center, Woolfson Eye Institute, Atlanta, GA.
authors: Bhairavi
authors: B
authors: Kharod-Dholakia
authors: J Bradley
authors: JB
authors: Randleman
authors: Jennifer G
authors: JG
authors: Bromley
authors: R Doyle
authors: RD
authors: Stulting
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003316:Corneal Diseases / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000706:statistics & numerical data*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control*; D006306:Health Surveys; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D009885:Ophthalmology / Q000458:organization & administration / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012955:Societies, Medical / Q000458:organization & administration; D014481:United States / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions