Long-Term Efficacy and Safety of Fluorometholone 0.1% Use After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To assess rates of steroid-induced ocular hypertension, de novo glaucoma, and rejection episodes with long term, off-label use of fluorometholone 0.1% after Descemet membrane endothelial keratoplasty (DMEK) in patients without preexisting glaucoma.

METHODS

We retrospectively reviewed records of 250 patients without previous glaucoma, who underwent DMEK between 2015 and 2019, used prednisolone acetate 1% for 2 months, and then switched to fluorometholone 0.1%, used indefinitely. Subjects with prior penetrating keratoplasty or <5-year follow-up were excluded. Main outcomes were rates of postoperative steroid-induced ocular hypertension, glaucoma, and rejection episodes, assessed with Kaplan-Meier analysis, taking follow-up into consideration.

RESULTS

The indications for DMEK were Fuchs dystrophy (94%), failed endothelial keratoplasty (4%), and secondary corneal edema (2%). The median patient age was 67 years (range 35-89 years), and median follow-up was 7 years (range 5-9 years). The cumulative rate of steroid-induced ocular hypertension was 2% at 1 year, 5% at 5 years, and 7% at 8 years. The cumulative rate of glaucoma was 2% at 1 year, 4% at 5 years, and 4% at 8 years; all cases of de novo glaucoma were managed medically and did not require surgical intervention. The cumulative rate of definite rejection episodes was 1% at 1 year, 1% at 5 years, and 2% at 8 years.

CONCLUSIONS

Long-term use of fluorometholone 0.1% after DMEK results in low rates of steroid induced ocular hypertension, de novo glaucoma, and immunologic rejection in patients without prior glaucoma.