[Current practice of immune prophylaxis and therapy in perforating keratoplasty. A survey of members of the Cornea Section of the German Ophthalmological Society]

Abstract

Purpose: Different strategies are currently used for prophylaxis and therapy of immunological transplant reactions. The aim of the present study was to evaluate clinical practice in planning and treatment of perforating keratoplasty (KPL) in Germany.

Method: A questionnaire was sent out to 148 members of the cornea section of the German Ophthalmological Society. The return consisted of 69 (47%) questionnaires representing 69% of institutions, 39% of responses returned from institutions performing <50 KPL/year, 15% from institutions operating >100 KPL and 4% from centres performing >300 KPL/year.

Results: Of the responders 13% currently never use HLA-matched grafts, 22% choose matched grafts in every risk KPL and 1.5% always use matched grafts. In normal risk situations 1.5% treat less than 2 weeks with topical steroids, 66% 3-12 months, 6.5% >1 year, 35% additionally treat with systemic steroids. Cyclosporine A (CsA) (92%) is besides steroids (80%) the most common systemic immunomodulatory agent in high risk situations, while methotrexate is used by only 9.5%. The duration of immunosuppressive therapy varies from <3 months (9%) up to >12 months (14%). The postoperative therapy after KPL in herpes includes topical (51%) and systemic aciclovir <3 (26%) and >3 weeks (67%) and additional systemic immunomodulatory agents (37%). The acute immune reaction is treated predominantly with steroids: topical (95%), subconjunctival (29%), intracameral (1.5%). Systemic steroids are given orally (48%) and intravenously (42%), 12% treat with topical CsA.

Conclusions: Besides therapeutic options that are accepted as common practice (e.g. systemic CsA) clinical practice varies widely. This may reflect the lack of evidence-based clinical observations.