Journal of cataract and refractive surgery · 2025
Prescription patterns in DMEK: European survey.
СтатьяНазвание и аннотация: Перевод в очереди
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Ye Yexin, de Rooij Fabio, Alejandre Nicolas, van den Biggelaar Frank J H M, Bourcier Tristan, Cochener-Lamard Béatrice, Figueiredo Francisco C, Galarreta David J, Hjortdal Jesper Ø, Jones Gary L A, Nathan Naomi, Nuijts Rudy M M A, Romano Vito, Rosa Andreia M, Seitz Berthold, Tassignon Marie-José, Wacker Katrin, Dickman Mor M
Аннотация
PURPOSE: To assess current prescription patterns in Descemet membrane endothelial keratoplasty (DMEK) in Europe.
SETTING: Countries affiliated with the European Cornea and Cell Transplantation Registry and the European Vision Institute Clinical Research Network.
DESIGN: Cross-sectional study (European survey).
METHODS: An electronic survey was distributed to 16 national societies to gather data on prescription patterns for DMEK. Responses were categorized by 3 clinical goals: prevention of postoperative endophthalmitis, graft rejection, and pupillary block and glaucoma.
RESULTS: Responses from 136 surgeons revealed that medication protocols mainly came from departmental protocols (54%) or personal experiences (48%) rather than national guidelines (22%) (multiple answers were allowed). Infection prevention primarily relied on intraoperative (72%) and postoperative (92%) antibiotics, with preoperative use less common (18%). Steroids were the mainstay for rejection prevention, used intraoperatively (59%), postoperatively (100%), and occasionally preoperatively (13%). Steroids were typically tapered to once daily after 6 months (46%) and discontinued after varying durations (65%). Dexamethasone was the preferred steroid. For high-risk DMEK, the most common approach was adding another topical (30%) or systemic immunosuppressive drug (24%), such as cyclosporine or mycophenolate. For graft rejection, most respondents increased topical steroid frequency (85%) or added (peri)bulbar steroid injections (42%). Pupillary block and glaucoma prophylaxis mainly involved intraoperative mydriatics (34%); intraocular pressure-lowering agents were rarely used (0.7% to 2.2%). For steroid-induced ocular hypertension, the common approach was switching to a lower-potency steroid (40%) or reducing steroid frequency (43%).
CONCLUSIONS: Current prescription patterns in routine and high-risk DMEK vary significantly, reflecting the lack of standardized guidelines.
SETTING: Countries affiliated with the European Cornea and Cell Transplantation Registry and the European Vision Institute Clinical Research Network.
DESIGN: Cross-sectional study (European survey).
METHODS: An electronic survey was distributed to 16 national societies to gather data on prescription patterns for DMEK. Responses were categorized by 3 clinical goals: prevention of postoperative endophthalmitis, graft rejection, and pupillary block and glaucoma.
RESULTS: Responses from 136 surgeons revealed that medication protocols mainly came from departmental protocols (54%) or personal experiences (48%) rather than national guidelines (22%) (multiple answers were allowed). Infection prevention primarily relied on intraoperative (72%) and postoperative (92%) antibiotics, with preoperative use less common (18%). Steroids were the mainstay for rejection prevention, used intraoperatively (59%), postoperatively (100%), and occasionally preoperatively (13%). Steroids were typically tapered to once daily after 6 months (46%) and discontinued after varying durations (65%). Dexamethasone was the preferred steroid. For high-risk DMEK, the most common approach was adding another topical (30%) or systemic immunosuppressive drug (24%), such as cyclosporine or mycophenolate. For graft rejection, most respondents increased topical steroid frequency (85%) or added (peri)bulbar steroid injections (42%). Pupillary block and glaucoma prophylaxis mainly involved intraoperative mydriatics (34%); intraocular pressure-lowering agents were rarely used (0.7% to 2.2%). For steroid-induced ocular hypertension, the common approach was switching to a lower-potency steroid (40%) or reducing steroid frequency (43%).
CONCLUSIONS: Current prescription patterns in routine and high-risk DMEK vary significantly, reflecting the lack of standardized guidelines.