Prevention and treatment of corneal graft rejection: Current practice patterns (2004)

Purpose: This study was designed to analyze current practice patterns in the prevention and treatment of corneal graft rejection and to compare these patterns with previously reported practices. Methods: In January 2004, a survey addressing the routine postoperative management of corneal transplants and the treatment of various manifestations of corneal graft rejection was sent to members of The Cornea Society. Results: Of the 396 surveys, 1 1 1 (28%) were returned and analyzed. All respondents used topical corticosteroids for routine postoperative management and treatment of endothelial graft rejection. Prednisolone, in brand or generic form, was used by 37 to 90% for routine management in various clinical scenarios and 81 to 91% for various manifestations of graft rejection at all time points; however, after 6 months, 12 to 26% used loteprednol etabonate for routine management. For routine management of high-risk grafts, 48% used topical cyclosporine in addition to prednisolone. Compared with previous surveys, the use of oral steroids significantly decreased for the routine management of high-risk corneal transplants, and the use of subconjunctival steroids decreased for the management of graft rejection. Conclusions: Topical prednisolone remains the mainstay for the prevention and treatment of corneal graft rejection; however, the role of newer agents, loteprednol etabonate and topical cyclosporine, is expanding.