Universität zu Köln

Bachmann, Bjoern O., Pleyer, Uwe, Maier, Philip Christian, Reinhard, Thomas, Seitz, Berthold ORCID: 0000-0001-9701-8204 and Cursiefen, Claus (2019). Perioperative/Postoperative Anti-Inflammatory Therapy During/After Corneal Surgery/Transplantation. Klinische Monatsblat. Augenheilkunde, 236 (5). S. 653 - 662. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-3999

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Abstract

Surgical trauma, and foreign material - such as sutures or implants or antigens during tissue transplantation - may cause inflammatory reactions. Inflammatory reactions after surgical interventions distant from the vascularised limbus and without opening of the anterior chamber of the eye are usually very muted, because of the corneal immune and angiogenic privilege. A milestone in the therapy and prophylaxis of inflammation after corneal surgery has been the use of topical glucocorticoids since the 1950s. When these are used, it is important to consider the cataractogenic effect of long-term use, the possibility of steroid-induced increase in intraocular pressure (so-called steroid response), the increased risk for microbial infection and the inhibition of epithelialisation. The available glucocorticoids differ in their ability to penetrate into the eye (prednisolone best), their immunosuppressive activity (dexamethasone best) and their ability to induce a steroid response (loteprednol etabonate and fluorometholone least). Preservative-free formulations are only available for dexamethasone. The different properties must be taken into account when choosing the best glucocorticoid: If there is a risk of delay in epithelialisation of the wound, topical steroids should be avoided or if necessary, phosphate-and preservative-free dexamethasone should be used with caution. If efficiency in the posterior cornea or in the anterior chamber is important, e.g. after penetrating keratoplasty, prednisolone acetate should be used. If a steroid response is known, loteprednol etabonate or fluorometholone should be used. When allogeneic tissue is transplanted, long-term topical glucocorticoid use over 24 months or longer is necessary. After high-risk keratoplasty with allogeneic donor tissue, supplemental systemic immunosuppressive therapy with calcineurin inhibitors or mycophenolate mofetil over 6 to 12 months is recommended.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bachmann, Bjoern O. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pleyer, Uwe UNSPECIFIED UNSPECIFIED UNSPECIFIED Maier, Philip Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Reinhard, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Seitz, Berthold UNSPECIFIED orcid.org/0000-0001-9701-8204 UNSPECIFIED Cursiefen, Claus UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-149375
DOI:	10.1055/a-0864-4793
Journal or Publication Title:	Klinische Monatsblat. Augenheilkunde
Volume:	236
Number:	5
Page Range:	S. 653 - 662
Date:	2019
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-3999
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HIGH-RISK KERATOPLASTY; POSTERIOR LAMELLAR KERATOPLASTY; PREDNISOLONE ACETATE 1-PERCENT; GLUCOCORTICOID-INDUCED CHANGES; INTRAOCULAR-PRESSURE RESPONSE; CYCLOSPORINE-A; MYCOPHENOLATE-MOFETIL; SYSTEMIC IMMUNOSUPPRESSION; MATRIX METALLOPROTEINASES; LOTEPREDNOL ETABONATE Multiple languages Ophthalmology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14937