Prescription Patterns in Descemet Membrane Endothelial Keratoplasty (DMEK): A European Survey.

IF 2.6 3区医学 Q2 OPHTHALMOLOGY

Journal of cataract and refractive surgery Pub Date : 2025-06-20 DOI:10.1097/j.jcrs.0000000000001726

Yexin Ye, Fabio de Rooij, Nicolas Alejandre, Frank J H M van den Biggelaar, Tristan Bourcier, Béatrice Cochener-Lamard, Francisco C Figueiredo, David J Galarreta, Jesper Ø Hjortdal, Gary L A Jones, Naomi Nathan, Rudy M M A Nuijts, Vito Romano, Andreia M Rosa, Berthold Seitz, Marie-José Tassignon, Katrin Wacker, Mor M Dickman

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引用次数: 0

Abstract

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 (ECCTR) and the European Vision Institute Clinical Research Network (EVICR.net).

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 three 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 six 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 (0.7-2.2%). 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.

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视网膜膜内皮角膜移植术（DMEK）的处方模式：一项欧洲调查。

目的：评估目前欧洲视网膜膜内皮角膜移植术（DMEK）的处方模式。背景：隶属于欧洲角膜和细胞移植登记处（ECCTR）和欧洲视力研究所临床研究网络（EVICR.net）的国家。设计：横断面研究（欧洲调查）。方法：对16个国家协会进行电子调查，收集DMEK处方模式的数据。反应分为三个临床目标：预防术后眼内炎、移植物排斥反应、瞳孔阻滞和青光眼。结果：136名外科医生的回答显示，用药方案主要来自科室方案（54%）或个人经验（48%），而不是国家指南（22%）（允许多次回答）。感染预防主要依赖于术中（72%）和术后（92%）抗生素，术前使用较少（18%）。类固醇是预防排斥反应的主要药物，术中使用（59%），术后使用（100%），偶尔术前使用（13%）。类固醇通常在六个月后逐渐减少到每天一次（46%），并在不同的持续时间后停用（65%）。地塞米松是首选类固醇。对于高风险DMEK，最常见的方法是添加另一种局部（30%）或全身免疫抑制药物（24%），如环孢素或霉酚酸盐。对于移植物排斥反应，大多数应答者增加局部类固醇频率（85%）或增加（周围）球类固醇注射（42%）。术中瞳孔阻滞和青光眼预防主要涉及心绞痛（34%）；眼压降药很少使用（0.7-2.2%）。对于类固醇引起的高眼压，常见的方法是改用低效类固醇（40%）或减少类固醇使用频率（43%）。结论：目前常规DMEK和高风险DMEK的处方模式差异很大，反映了缺乏标准化的指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

$Journal of cataract and refractive surgery$

Journal of cataract and refractive surgery 医学-外科

CiteScore

5.60

自引率

14.30%

发文量

259

审稿时长

8.5 weeks

期刊介绍： The Journal of Cataract & Refractive Surgery (JCRS), a preeminent peer-reviewed monthly ophthalmology publication, is the official journal of the American Society of Cataract and Refractive Surgery (ASCRS) and the European Society of Cataract and Refractive Surgeons (ESCRS). JCRS publishes high quality articles on all aspects of anterior segment surgery. In addition to original clinical studies, the journal features a consultation section, practical techniques, important cases, and reviews as well as basic science articles.