title: Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery.
abstract: OBJECTIVE
  To analyze the effect of intensified topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (triple-DMEK) on the incidence of postoperative cystoid macular edema (CME).
  
  
  METHODS
  Single-center comparative clinical study with historical controls.
  
  
  METHODS
  
  
  
  METHODS
  Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year.
  
  
  METHODS
  Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. Inclusion Criterion: Triple-DMEK surgery.
  
  
  METHODS
  Prior retinal surgery, history of prior CME.
  
  
  METHODS
  Prednisolone acetate eye drops 1% 5 times daily for the first week after surgery. After an internal change of therapy regimen: Prednisolone acetate eye drops 1% hourly for the first postoperative week. We compared 75 consecutive eyes before with 75 consecutive eyes after the change of therapy regimen. Patients received macular spectral-domain optical coherence tomography (SD OCT) preoperatively, as well as 6 weeks and 3 and 6 months post surgery.
  
  
  METHODS
  Development of CME detected by macular SD OCT during 6 months postoperatively.
  
  
  RESULTS
  Both groups were comparable regarding baseline age, sex, central corneal thickness, rebubbling rate, and visual acuity. With topical steroid therapy 5 times per day during the first postoperative week, we observed 9 cases of subsequent CME (12%). With hourly topical steroid therapy none of the patients developed CME subsequently (P = .003). Apart from the topical steroids during the first week, medical treatment was identical in both groups.
  
  
  CONCLUSIONS
  Early intensified postoperative topical steroid therapy constitutes an effective prophylactic treatment to reduce incidence of CME after triple-DMEK surgery.
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany. Electronic address: r.hoerster@me.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoerster
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Tisha Prabriputaloong
authors.initials: TP
authors.lastname: Stanzel
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Bjoern Olov
authors.initials: BO
authors.lastname: Bachmann
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebelmann
authors.affiliation: Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Felsch
authors.affiliation: Department of Ophthalmology, University of Cologne, Cologne, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications; D003316:Corneal Diseases / Q000150:complications; D057111:Descemet Stripping Endothelial Keratoplasty; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000517:prevention & control; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; C009935:prednisolone acetate; D011239:Prednisolone