Topical Difluprednate for Early Corneal Graft Rejection After Penetrating Keratoplasty

Purpose To evaluate the safety and efficacy of topical difluprednate ophthalmic emulsion use for prophylaxis of corneal graft rejection in patients undergoing penetrating keratoplasty. Methods This study reviewed the charts of patients undergoing penetrating keratoplasty who were treated with difluprednate (DP) ophthalmic emulsion postoperatively. At each follow-up visit, patients were followed for signs of graft rejection, cataract development, and intraocular pressure rise in addition to routine ocular examination. Results The charts of 36 patients (38 eyes) who underwent penetrating keratoplasty (PKP) (27 eyes) and PKP triple (11 eyes) were reviewed. All eyes were followed up for at least 8 months postoperatively. Five grafts developed rejection and three grafts subsequently failed. Six eyes had an increase of IOP that required use of antiglaucoma drops. Three eyes were switched from difluprednate to prednisolone acetate (PA) after persistent rise of IOP failed to respond to antiglaucoma drops. None of these cases needed glaucoma surgery. Two patients developed cataract during the follow-up period (out of 12 phakic eyes). Conclusion Topical difluprednate is potentially effective and safe in preventing graft rejection after penetrating keratoplasty. Larger prospective clinical trials are warranted.

[1]  D. Jabs,et al.  Risk of Cataract Development among Children with Juvenile Idiopathic Arthritis-Related Uveitis Treated with Topical Corticosteroids. , 2020, Ophthalmology.

[2]  I. B. Pedersen,et al.  Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure , 2015, Acta ophthalmologica.

[3]  D. Roth,et al.  INCIDENCE OF STEROID-INDUCED OCULAR HYPERTENSION AFTER VITREORETINAL SURGERY WITH DIFLUPREDNATE VERSUS PREDNISOLONE ACETATE , 2014, Retina.

[4]  E. Holland,et al.  A multicenter randomized controlled fellow eye trial of pulse-dosed difluprednate 0.05% versus prednisolone acetate 1% in cataract surgery. , 2011, American journal of ophthalmology.

[5]  W. Stringer,et al.  Dose uniformity of topical corticosteroid preparations: difluprednate ophthalmic emulsion 0.05% versus branded and generic prednisolone acetate ophthalmic suspension 1% , 2010, Clinical ophthalmology.

[6]  D. Jabs,et al.  Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. , 2010, Ophthalmology.

[7]  S. Kaye,et al.  Long-term topical steroid treatment after penetrating keratoplasty in patients with pseudophakic bullous keratopathy. , 2009, Ophthalmology.

[8]  D. Callanan,et al.  The role of difluprednate ophthalmic emulsion in clinical practice , 2009, Clinical ophthalmology.

[9]  K. Tabbara.  Pharmacologic strategies in the prevention and treatment of corneal transplant rejection , 2008, International Ophthalmology.

[10]  A. Panda,et al.  Corneal graft rejection. , 2007, Survey of ophthalmology.

[11]  R. D. Stulting,et al.  Prevention and Treatment of Corneal Graft Rejection: Current Practice Patterns (2004) , 2006, Cornea.

[12]  D. Coster,et al.  The impact of corneal allograft rejection on the long-term outcome of corneal transplantation. , 2005, American journal of ophthalmology.

[13]  S. Gupta,et al.  Cataract formation after penetrating keratoplasty , 1997, Journal of cataract and refractive surgery.

[14]  J. Krachmer,et al.  Clinical types of corneal transplant rejection. Their manifestations, frequency, preoperative correlates, and treatment. , 1981, Archives of ophthalmology.

[15]  M. Clement,et al.  PREVENTION AND TREATMENT , 1944 .