Pre-cut corneal donor tissues for primary DMEK grafts were obtained from the Barcelona Tissue Eye Bank. DMEK surgeries were all performed by a single surgeon (J.G.).The surgical technique for primary DMEK surgery was as previously described by our group10 (link),11 (link). DMEK graft positioning onto the recipient posterior stroma was performed using 20% sulfur hexafluoride (SF6) as tamponade. Subconjunctival dexamethasone 80 mg was administered at the end of the surgery. To ensure graft attachment with the aid of SF 20% bubble, patients were instructed on different positioning regimens in the early postoperative period, as we have previously described10 (link),11 (link).
Postoperative treatment was as we previously described12 (link),13 (link), and consisted of topical tobramycin 0.3% and dexamethasone 0.1% (Tobradex; Alcon Cusi, El Mas Nou, Barcelona, Spain) every 2 h for the first postoperative day, then 6 times daily for one week, then 4 times daily for 4 weeks and then tapering over the following 3 months (reduction in 1 drop every 4 weeks); timolol 0.5% (Cusimolol; Alcon Cusi) eye drops 2 times daily for 12 weeks, with additional ocular hypotensive medications if needed; and dexamethasone 0.05% and chloramphenicol 1% ointment at nighttime (DeIcol; Alcon Cusi) for 6 months. Oral methylprednisolone (Urbason; Sanofi Aventis Pharma SA, Barcelona, Spain) was also prescribed and slowly tapered off for the first 3 weeks: 40 mg/day for 3 days; 20 mg/day for 3 more days; 10 mg/day for 1 week; and 10 mg every 48 h for 1 week. A topical corticosteroid was kept at least once daily indefinitely after DMEK, unless contraindicated in light of significant increases in intraocular pressure.
In patients with vs-CMO after DMEK, first-line treatment consisted of adding a topical non-steroidal anti-inflammatory (NSAID) drug twice daily (either bromfenac 0.9 mg/mL (Yellox, Bausch & Lomb) or nepafenac 0.1 mg/mL (Nevanac, Novartis)) to the topical steroid regime plus oral acetazolamide 250 mg three times per day (plus oral potassium supplementation) until resolution of CMO. In cases of incomplete response to first-line treatment, the second-line treatment consisted of intravitreal injection of corticosteroids.
Postoperative treatment was as we previously described12 (link),13 (link), and consisted of topical tobramycin 0.3% and dexamethasone 0.1% (Tobradex; Alcon Cusi, El Mas Nou, Barcelona, Spain) every 2 h for the first postoperative day, then 6 times daily for one week, then 4 times daily for 4 weeks and then tapering over the following 3 months (reduction in 1 drop every 4 weeks); timolol 0.5% (Cusimolol; Alcon Cusi) eye drops 2 times daily for 12 weeks, with additional ocular hypotensive medications if needed; and dexamethasone 0.05% and chloramphenicol 1% ointment at nighttime (DeIcol; Alcon Cusi) for 6 months. Oral methylprednisolone (Urbason; Sanofi Aventis Pharma SA, Barcelona, Spain) was also prescribed and slowly tapered off for the first 3 weeks: 40 mg/day for 3 days; 20 mg/day for 3 more days; 10 mg/day for 1 week; and 10 mg every 48 h for 1 week. A topical corticosteroid was kept at least once daily indefinitely after DMEK, unless contraindicated in light of significant increases in intraocular pressure.
In patients with vs-CMO after DMEK, first-line treatment consisted of adding a topical non-steroidal anti-inflammatory (NSAID) drug twice daily (either bromfenac 0.9 mg/mL (Yellox, Bausch & Lomb) or nepafenac 0.1 mg/mL (Nevanac, Novartis)) to the topical steroid regime plus oral acetazolamide 250 mg three times per day (plus oral potassium supplementation) until resolution of CMO. In cases of incomplete response to first-line treatment, the second-line treatment consisted of intravitreal injection of corticosteroids.
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