Intensified Early Postoperative Topical Steroids Do Not Influence Endothelial Cell Density After Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery (Triple-DMEK)

Purpose: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 5x 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(2), respectively. ECD of grafts in group 2 was 2696 +/- 267, 1737 +/- 450, and 1694 +/- 482 cells/mm(2), 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