Intracameral Dexamethasone Injection as Adjuvant Therapy in Endothelial Immune Reaction After Penetrating and Posterior Lamellar Keratoplasty: A Retrospective Clinical Observation

Abstract

The aim of this observational study is to evaluate the effectiveness of an adjuvant intracameral corticosteroid injection (ICI) in cases of severe endothelial immune reaction (SEIR) (anterior chamber cells and flare, retrocorneal precipitates, Descemet's folds, and corneal edema) after penetrating keratoplasty and posterior lamellar keratoplasty. In this retrospective study, 24 subjects treated between November 2011 and September 2014 were divided into two groups. The control group received topical and systemic steroid therapy while the study group received additionally ICI (400µg dexamethasone). Outcome measures included changes in best corrected visual acuity (BCVA), central corneal thickness (CCT, Pentacam), endothelial cell count (ECC), and intraocular pressure (IOP). The follow-up examinations were conducted after a period of 6weeks and 3months. Results were compared using the Wilcoxon signed-rank test. BCVA of the patients in the study group increased from logMAR 1.5±0.77 at baseline to 0.99±0.44 (p=0.009) at 6weeks and to 0.78±0.45 (p=0.017) at 3months following the ICI. The CCT decreased from 835±211µm at baseline to 609±63µm (p=0.005) after 3months. ECC showed a significant reduction 12weeks after treatment in both groups (p=0.012 in the control group and p=0.005 in the study group). This reflects a mean ECC loss of 17% and 19% due to the immune reaction in the control and study group, respectively. A significant temporary increase in the IOP was documented only in the control group (p=0.005). The ICI seems to be a safe adjuvant approach, which improves therapeutic efficacy of SEIR after keratoplasty.