Immune Prophylaxis and Therapy in Perforating Keratoplasty: An Inquiry of Members of Corneal Section of DOG
Bertelmann E.1, Reinhard T.2, Pleyer U.1
1Augenklinik Charité Campus Virchow-Klinikum, Humboldt Univ. Berlin; 2Augenklinik der Heinrich-Heine-Universität Düsseldorf
Purpose: Different strategies are currently used for prophylaxis and therapy of immunological transplant reactions. Aim of the present study was to evaluate clinical practice in planning and treatment of perforating keratoplasty (KPL) in Germany.
Method: A questionnaire was send out to 148 members of corneal section of DOG. 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: 13% of responders never use a HLA-matched graft, 22% choose matched grafts in every risk KPL, 1.5% use always 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 % treat additionally with systemic steroids. Cyclosporine A (92%) is besides steroids (80%) the most common immunomodulatory agent in high risk situations, while methotrexate is used only by 9.5%. The duration of immunosuppressive therapy reaches 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 week
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