PMID- 19815284 OWN - NLM STAT- MEDLINE DCOM- 20091211 LR - 20091201 IS - 1549-4713 (Electronic) IS - 0161-6420 (Linking) VI - 116 IP - 12 DP - 2009 Dec TI - Long-term topical steroid treatment after penetrating keratoplasty in patients with pseudophakic bullous keratopathy. PG - 2369-72 LID - 10.1016/j.ophtha.2009.06.006 [doi] AB - PURPOSE: To assess the use of long-term topical corticosteroid treatment in patients with pseudophakic bullous keratopathy (PBK) after penetrating keratoplasty (PK). DESIGN: Retrospective cohort study. PARTICIPANTS: This study considered patients with PBK undergoing an initial PK procedure for visual reasons in the United Kingdom between April 1999 and March 2004. There were 1274 initial PK procedures for PBK reported to United Kingdom Transplant in this period, of which 1184 (91%) were grafted for visual reasons. Of these 1184 grafts, follow-up was reported in 1033 instances (87%). METHODS: A Cox regression model was used to investigate the combined effects of all preoperative factors (recipient age, human leukocyte antigen [HLA] matching, trephine size, deep stromal vascularization, surgeon activity) on graft failure. The model was fitted using all preoperative factors first, and subsequently, factors associated with corticosteroid and other medications were included. MAIN OUTCOME MEASURES: Graft survival. RESULTS: Three-year survival of grafts for PBK was 65% (95% confidence interval [CI], 59%-70%). Topical corticosteroids were still being used beyond 18 months after surgery in 378 (37%) of the 1033 corneal grafts included in this study. The grafts of patients not currently receiving steroids were 1.5 times as likely to fail (hazard ratio [HR], 1.5; 95% CI, 1.0-2.2; P<0.03). Lack of HLA matching (P = 0.006), trephine size or=8.00 mm (P = 0.03), recipient age younger than 65 years (P = 0.003), and corneal vascularization (P = 0.04) all increased the risk of graft failure. CONCLUSIONS: The use of long-term postoperative corticosteroids improved graft survival after PK for PBK. Barring patient contraindications for long-term topical corticosteroid use, clinicians should consider maintaining patients with PBK on long-term postoperative corticosteroid maintenance. FAU - Ross, Adam H AU - Ross AH AD - Bristol Eye Hospital, Bristol, United Kingdom. adamross@doctors.org.uk FAU - Jones, Mark N A AU - Jones MN FAU - Nguyen, Dan Q AU - Nguyen DQ FAU - Jaycock, Philip D AU - Jaycock PD FAU - Armitage, W John AU - Armitage WJ FAU - Cook, Stuart D AU - Cook SD FAU - Kaye, Stephen B AU - Kaye SB FAU - Tole, Derek M AU - Tole DM CN - National Health Service Blood and Transplant Ocular Tissue Advisory Group and Contributing Ophthalmologists LA - eng PT - Journal Article DEP - 20091007 PL - United States TA - Ophthalmology JT - Ophthalmology JID - 7802443 RN - 0 (Glucocorticoids) SB - IM MH - Administration, Topical MH - Aged MH - Aged, 80 and over MH - Cataract Extraction/adverse effects MH - Corneal Edema/etiology/*surgery MH - Female MH - Follow-Up Studies MH - Glucocorticoids/*administration & dosage MH - Graft Survival/*drug effects MH - Humans MH - *Keratoplasty, Penetrating MH - Male MH - Postoperative Care/methods MH - Pseudophakia/etiology/*surgery MH - Retrospective Studies MH - Risk Factors EDAT- 2009/10/10 06:00 MHDA- 2009/12/16 06:00 CRDT- 2009/10/10 06:00 PHST- 2008/12/09 00:00 [received] PHST- 2009/05/28 00:00 [revised] PHST- 2009/06/30 00:00 [accepted] PHST- 2009/10/10 06:00 [entrez] PHST- 2009/10/10 06:00 [pubmed] PHST- 2009/12/16 06:00 [medline] AID - S0161-6420(09)00608-3 [pii] AID - 10.1016/j.ophtha.2009.06.006 [doi] PST - ppublish SO - Ophthalmology. 2009 Dec;116(12):2369-72. doi: 10.1016/j.ophtha.2009.06.006. Epub 2009 Oct 7.