Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery
Intensified Topical Steroids as Prophylaxis for Macular Edema After Posterior Lamellar Keratoplasty Combined With Cataract Surgery
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DOI：
10.1016/j.ajo.2015.12.008
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发表时间：
2016-03-01
影响因子：
4.2
通讯作者：
Cursiefen, Claus
中科院分区：
文献类型：
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作者：
Hoerster, Robert;Stanzel, Tisha Prabriputaloong;Cursiefen, Claus
目的：分析Descemet膜内皮细胞角膜移植联合白内障手术(Triple-DMEK)后强化局部激素治疗对术后黄斑囊样水肿(CME)发生率的影响。设计：单中心临床对照研究。方法：单位：德国科隆大学眼科，三级医院，每年进行500例角膜移植手术。患者：共131例(150只眼)接受三次DMEK手术。纳入标准：三次DMEK手术。排除标准：既往视网膜手术、既往CME病史。干预：术后第1周，每日5次，每次1%强的松龙滴眼液。治疗方案内部改变后：术后第一周每小时滴1%醋酸泼尼松龙滴眼液。我们比较了改变治疗方案前的75只连续眼和改变治疗方案后的75只眼。术前、术后6周、术后3个月和6个月行黄斑光谱域光学相干断层扫描(SD OCT)。主要观察指标：术后6个月黄斑SD OCT检测CME的进展情况。结果：两组在基线年龄、性别、中央角膜厚度、再气泡率和视力方面具有可比性。术后第一周每日外用5次类固醇治疗，观察到9例(12%)继发CME。接受每小时一次的局部类固醇治疗后，无一例患者随后发生CME(P=0.003)。除第一周局部应用类固醇外，两组的内科治疗相同。结论：术后早期强化局部类固醇治疗是降低三联DMEK术后CME发生率的有效预防措施。(C)2016，由Elsevier Inc.保留所有权利。
PURPOSE: 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).DESIGN: Single-center comparative clinical study with historical controls.METHODS: SETTING: Department of Ophthalmology, University of Cologne, Germany, tertiary hospital, performing 500 corneal transplant surgeries per year. PATIENTS: Total of 131 patients (150 eyes) undergoing triple-DMEK surgery. INCLUSION CRITERION: Triple-DMEK surgery. EXCLUSION CRITERIA: Prior retinal surgery, history of prior CME. INTERVENTIONS: 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. MAIN OUTCOME MEASURE: 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. (C) 2016 by Elsevier Inc. All rights reserved.