TY - JOUR
T1 - Prescription Patterns in Descemet Membrane Endothelial Keratoplasty (DMEK)
T2 - A European Survey
AU - Ye, Yexin
AU - de Rooij, Fabio
AU - Alejandre, Nicolas
AU - van den Biggelaar, Frank J H M
AU - Bourcier, Tristan
AU - Cochener-Lamard, Béatrice
AU - Figueiredo, Francisco C
AU - Galarreta, David J
AU - Hjortdal, Jesper Ø
AU - Jones, Gary L A
AU - Nathan, Naomi
AU - Nuijts, Rudy M M A
AU - Romano, Vito
AU - Rosa, Andreia M
AU - Seitz, Berthold
AU - Tassignon, Marie-José
AU - Wacker, Katrin
AU - Dickman, Mor M
N1 - Publisher Copyright:
© 2025 The Author(s).
PY - 2025/11/1
Y1 - 2025/11/1
N2 - 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.
AB - 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.
KW - Cornea
KW - DMEK
KW - Endothelial keratoplasty
KW - Graft Rejection
KW - Steroids
UR - https://www.scopus.com/pages/publications/105009620827
U2 - 10.1097/j.jcrs.0000000000001726
DO - 10.1097/j.jcrs.0000000000001726
M3 - Article
C2 - 40558573
SN - 0886-3350
VL - 51
SP - 941
EP - 947
JO - Journal of Cataract and Refractive Surgery
JF - Journal of Cataract and Refractive Surgery
IS - 11
ER -