Steroid treatment: the long and the short of it

A study published in the March issue of Acta Ophthalmologica Scandinavica, has found that long-term treatment with a topical steroid after penetrating keratoplasty (PK) is no better at preserving endothelial cell density than short-term treatment.

Nhung Xuan Nguyen and colleagues from the University of Erlangen-Nürnberg, Germany, compared the effects of long- and short-term topical steroid use on endothelial cell counts in 305 subjects. All patients, after undergoing PK, received prednisolone acetate 1% eye drops five times a day. This was slowly tapered over a six-month period. Patients were randomly assigned to the short-term group, which ceased steroid treatment, or the long-term group, which continued with the treatment once daily for a further 12 months.

A significant postoperative decrease in endothelial cell density was observed in both groups. At six-week follow-up, cell densities averaged 1,941 cells/mm² in the short-term group and 1,957 cells/mm² in the long-term group. At two-year follow-up, cell density had decreased significantly to 1,535 cells/mm² and 1,472 cells/mm², respectively (p<0.001).

Using linear regression, the researchers calculated that subjects in the short-term group lost an average of 216 cells/mm² per year, while those in the long-term group lost an average of 206 cells/mm² (p=0.5).

Analysis of the results revealed that there is no significant difference in cell density between patients on long- and short-term steroid treatment following penetrating keratoplasty.