title: Intensified Early Postoperative Topical Steroids Do Not Influence Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery (Triple-DMEK).
abstract: OBJECTIVE
  To investigate the effect of intensified postoperative topical steroid therapy after Descemet membrane endothelial keratoplasty combined with cataract surgery (Triple-DMEK) on postoperative endothelial cell density (ECD).
  
  
  METHODS
  This comparative clinical study with historical controls was conducted at a tertiary hospital, specialized in corneal surgery. Patients undergoing DMEK or Triple-DMEK are included prospectively in the Cologne DMEK Database. Until April 2014, first week's postoperative standard therapy for lamellar keratoplasties was prednisolone acetate eye drops 1% applied 5× daily. After April 2014, first week's postoperative standard therapy changed to prednisolone acetate eye drops 1% applied hourly. We compared 75 consecutive eyes before (group 1) with 75 consecutive eyes after the change of therapy regimen (group 2). Patients received ECD analysis 3 and 6 months after surgery.
  
  
  RESULTS
  ECD of grafts in group 1 before transplantation, and 3 months and 6 months after surgery was 2697 ± 218, 1765 ± 349, and 1703 ± 432 cells/mm, respectively. ECD of grafts in group 2 was 2696 ± 267, 1737 ± 450, and 1694 ± 482 cells/mm, respectively. Over 3 and 6 months, ECD in group 1 decreased by 35% ± 13% and 38% ± 18%, respectively. In group 2, ECD decreased by 36% ± 16% and 38% ± 16%, respectively. Neither absolute numbers nor decrease in ECD differed significantly between groups 1 and 2 at any time point (all P > 0.60).
  
  
  CONCLUSIONS
  Intensified early postoperative topical steroid therapy during the first postoperative week does not stabilize ECD, nor does it have a toxic effect on endothelial cells during a follow-up of 6 months.
authors.affiliation: *Department of Ophthalmology, University of Cologne, Cologne, Germany; and †Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoerster
authors.forename: Tisha P
authors.initials: TP
authors.lastname: Stanzel
authors.forename: Bjoern O
authors.initials: BO
authors.lastname: Bachmann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Siebelmann
authors.forename: Claus
authors.initials: C
authors.lastname: Cursiefen
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000187:drug effects*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D065386:Historically Controlled Study; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011182:Postoperative Care; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D009883:Ophthalmic Solutions; C009935:prednisolone acetate; D011239:Prednisolone