The study included 122 patients (mean follow-up 67 months, SD 5.6 years). The most common procedures were DSAEK (50%) & PKP (34%), with indications including Fuchs endothelial corneal dystrophy (50%), keratoconus (21%), and pseudophakic bullous keratopathy (17%). All received prednisolone acetate 1%, with some requiring additional steroids. Within 2 years, 25.4% had at least one graft rejection; rates were 37% in high-risk vs 21% in low-risk grafts (p = 0.07). Kaplan-Meier analysis showed higher rejection risk in patients ≥ 65 years (log-rank p = 0.003) and worse graft survival with above-median cumulative steroid exposure (log-rank p < 0.001). No significant differences were found by graft type or surgical risk. Data collection is ongoing.
Long-Term Topical Steroid Prophylaxis Beyond One Year After Keratoplasty: Real-World Outcomes From A Canadian Cohort
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR148 | Type: Free paper | DOI: 10.82333/pmdb-yx91
Authors: Dr Mona Koaik* 1 , Dr Cody Lo 1 , Mr Grant Luke 2 , Mr Arthur Gabriel 2 , Mr David Jin 2 , Ms Marah Elkabouli 3 , Mr Annelise Saunders 4 , Dr Abdullah Al-Kaabi 5 , Dr Setareh Ziai 1
1Ophthalmology,The Ottawa Hospital Research Institute,Ottawa,Canada;Ophthalmology,The Ottawa Hospital Eye Institute,Ottawa,Canada, 2The University of Ottawa,Ottawa,Canada, 3Ophthalmology,The Ottawa Hospital Research Institute,ottawa,Canada, 4Ophthalmology,The Ottawa Hospital Research Institute,Ottawa,Canada, 5Ophthalmology,The Ottawa Hospital Eye Institute,Ottawa,Canada;Ophthalmology,The Ottawa Hospital Research Institute,Ottawa,Canada
Purpose
Graft rejection remains a major cause of surgical morbidity. Previous studies have shown that topical steroids up to one year after surgery are associated with improved graft survival. However, the impact of long-term prophylaxis beyond one year remains poorly defined. This study evaluated the relationship between extended topical steroid use and outcomes of keratoplasty, with a focus on graft survival and complications. This represents one of the few studies to evaluate steroid prophylaxis beyond one year, and among the first to report long-term outcomes in a Canadian cohort including both penetrating and lamellar keratoplasty.
Setting
Retrospective cohort study.
Methods
A retrospective chart review was performed of consecutive keratoplasty cases at The Ottawa Hospital. Cases between 2009-2021 with a minimum of two years of postoperative follow-up were included. Both penetrating and lamellar keratoplasties were analyzed. Exclusion criteria included concurrent corneal or inflammatory ocular conditions or other indications for chronic topical steroid therapy. Prophylactic steroid type, duration, and dosing frequency were recorded. Primary outcomes were graft rejection and survival. Secondary outcomes assessed patient and surgical risk factors including patient age, cumulative steroid dose, surgical risk category, and graft type.
Results
Conclusions
This study demonstrated that age ≥ 65 and higher cumulative steroid exposure are associated with worse graft survival following keratoplasty. Patients with higher cumulative steroid exposure likely had worse baseline pathology. Interpretation was limited by the smaller sample size and retrospective design. Larger prospective studies are needed to clarify the role of long-term steroid prophylaxis and to optimize tapering strategies post-keratoplasty.