Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

Sonja Heinzelmann; Daniel Böhringer; Philip Christian Maier; Berthold Seitz; Claus Cursiefen; Anna-Karina B. Maier; Tina Dietrich-Ntoukas; Gerd Geerling; Arne Viestenz; Norbert Pfeiffer; Thomas Reinhard

doi:10.1055/a-1353-6149

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2021; 238(05): 591-597
DOI: 10.1055/a-1353-6149

Klinische Studie

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany

Article in several languages: English | deutsch

Authors

Sonja Heinzelmann

¹Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
Daniel Böhringer

¹Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
Philip Christian Maier

¹Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland
Berthold Seitz

²Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg (Saar), Deutschland
Claus Cursiefen

³Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
Anna-Karina B. Maier

⁴Klinik für Augenheilkunde, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Tina Dietrich-Ntoukas

⁴Klinik für Augenheilkunde, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Gerd Geerling

⁵Augenklinik, Universitätsklinikum Düsseldorf, Deutschland
Arne Viestenz

⁶Universitätsklinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle (Saale), Deutschland
Norbert Pfeiffer

⁷Augenklinik und Poliklinik, Universitätsmedizin Mainz, Deutschland
Thomas Reinhard

¹Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Deutschland

Abstract

Background Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres.

Objective The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany.

Methods Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated.

Results All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 – 5 times daily) and tapering (2 – 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days.

Discussion Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

Key words

keratoplasty - rejection - prophylaxis - suture - removal

Full Text

References

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