Long-Term Efficacy and Safety of Fluorometholone 0.1% Use After Descemet Membrane Endothelial Keratoplasty.

Purpose: To assess rates of steroid-induced ocular hypertension, de novo glaucoma, and rejection episodes with long term, off-label use of fluorometholone 0.1% after Descemet membrane endothelial keratoplasty (DMEK) in patients without preexisting glaucoma.

Methods: We retrospectively reviewed records of 250 patients without previous glaucoma, who underwent DMEK between 2015 and 2019, used prednisolone acetate 1% for 2 months, and then switched to fluorometholone 0.1%, used indefinitely. Subjects with prior penetrating keratoplasty or <5-year follow-up were excluded. Main outcomes were rates of postoperative steroid-induced ocular hypertension, glaucoma, and rejection episodes, assessed with Kaplan-Meier analysis, taking follow-up into consideration.

Results: The indications for DMEK were Fuchs dystrophy (94%), failed endothelial keratoplasty (4%), and secondary corneal edema (2%). The median patient age was 67 years (range 35-89 years), and median follow-up was 7 years (range 5-9 years). The cumulative rate of steroid-induced ocular hypertension was 2% at 1 year, 5% at 5 years, and 7% at 8 years. The cumulative rate of glaucoma was 2% at 1 year, 4% at 5 years, and 4% at 8 years; all cases of de novo glaucoma were managed medically and did not require surgical intervention. The cumulative rate of definite rejection episodes was 1% at 1 year, 1% at 5 years, and 2% at 8 years.

Conclusions: Long-term use of fluorometholone 0.1% after DMEK results in low rates of steroid induced ocular hypertension, de novo glaucoma, and immunologic rejection in patients without prior glaucoma.