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Prescription Patterns in Descemet Membrane Endothelial Keratoplasty (DMEK): A European Survey

Lookup NU author(s): Professor Francisco FigueiredoORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2025 The Author(s).Purpose:To assess current prescription patterns in Descemet Membrane Endothelial Keratoplasty (DMEK) in Europe.Setting:Countries affiliated with the European Cornea and Cell Transplantation Registry (ECCTR) and the European Vision Institute Clinical Research Network (EVICR.net).Design:Cross-sectional study (European survey).Methods:An electronic survey was distributed to 16 national societies to gather data on prescription patterns for DMEK. Responses were categorized by three clinical goals: prevention of postoperative endophthalmitis, graft rejection, and pupillary block and glaucoma.Results:Responses from 136 surgeons revealed that medication protocols mainly came from departmental protocols (54%) or personal experiences (48%) rather than national guidelines (22%) (multiple answers were allowed). Infection prevention primarily relied on intraoperative (72%) and postoperative (92%) antibiotics, with preoperative use less common (18%). Steroids were the mainstay for rejection prevention, used intraoperatively (59%), postoperatively (100%), and occasionally preoperatively (13%). Steroids were typically tapered to once daily after six months (46%) and discontinued after varying durations (65%). Dexamethasone was the preferred steroid. For high-risk DMEK, the most common approach was adding another topical (30%) or systemic immunosuppressive drug (24%), such as cyclosporine or mycophenolate. For graft rejection, most respondents increased topical steroid frequency (85%) or added (peri)bulbar steroid injections (42%). Pupillary block and glaucoma prophylaxis mainly involved intraoperative mydriatics (34%); intraocular pressure-lowering agents were rarely used (0.7-2.2%). For steroid-induced ocular hypertension, the common approach was switching to a lower-potency steroid (40%) or reducing steroid frequency (43%).Conclusions:Current prescription patterns in routine and high-risk DMEK vary significantly, reflecting the lack of standardized guidelines.

Publication metadata

Author(s): Ye Y, De Rooij F, Alejandre N, Van Den Biggelaar FJHM, Bourcier T, Cochener-Lamard B, Figueiredo FC, Galarreta DJ, Hjortdal J, Jones GLA, Nathan N, Nuijts RMMA, Romano V, Rosa AM, Seitz B, Tassignon M-J, Wacker K, Dickman MM

Publication type: Article

Publication status: Published

Journal: Journal of Cataract and Refractive Surgery

Year: 2025

Volume: 51

Issue: 11

Pages: 941-947

Print publication date: 01/11/2025

Online publication date: 20/06/2025

Acceptance date: 02/04/2018

Date deposited: 04/11/2025

ISSN (print): 0886-3350

ISSN (electronic): 1873-4502

Publisher: Lippincott Williams and Wilkins

URL: https://doi.org/10.1097/j.jcrs.0000000000001726

DOI: 10.1097/j.jcrs.0000000000001726

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