# Prescription patterns in DMEK: European survey

## TL;DR

A European survey shows that DMEK prescription practices vary widely, with few surgeons following national guidelines.

## Contribution

The study identifies the lack of standardized DMEK prescription protocols across Europe.

## Key findings

- Most surgeons rely on departmental protocols or personal experience rather than national guidelines.
- Steroids are the primary medication for preventing graft rejection, with dexamethasone being the most common.
- Intraoperative mydriatics are the main approach for pupillary block and glaucoma prophylaxis.

## Abstract

This comprehensive European survey reveals significant variability in DMEK prescription practices and highlights the need for standardized guidelines.

To assess current prescription patterns in Descemet membrane endothelial keratoplasty (DMEK) in Europe.

Countries affiliated with the European Cornea and Cell Transplantation Registry and the European Vision Institute Clinical Research Network.

Cross-sectional study (European survey).

An electronic survey was distributed to 16 national societies to gather data on prescription patterns for DMEK. Responses were categorized by 3 clinical goals: prevention of postoperative endophthalmitis, graft rejection, and pupillary block and glaucoma.

Responses from 136 surgeons revealed that medication protocols mainly came from departmental protocols (54%) or personal experiences (48%) rather than national guidelines (22%) (multiple answers were allowed). Infection prevention primarily relied on intraoperative (72%) and postoperative (92%) antibiotics, with preoperative use less common (18%). Steroids were the mainstay for rejection prevention, used intraoperatively (59%), postoperatively (100%), and occasionally preoperatively (13%). Steroids were typically tapered to once daily after 6 months (46%) and discontinued after varying durations (65%). Dexamethasone was the preferred steroid. For high-risk DMEK, the most common approach was adding another topical (30%) or systemic immunosuppressive drug (24%), such as cyclosporine or mycophenolate. For graft rejection, most respondents increased topical steroid frequency (85%) or added (peri)bulbar steroid injections (42%). Pupillary block and glaucoma prophylaxis mainly involved intraoperative mydriatics (34%); intraocular pressure–lowering agents were rarely used (0.7% to 2.2%). For steroid-induced ocular hypertension, the common approach was switching to a lower-potency steroid (40%) or reducing steroid frequency (43%).

Current prescription patterns in routine and high-risk DMEK vary significantly, reflecting the lack of standardized guidelines.