Pred forte

PKP was performed by a single experienced surgeon (T.I.K.) following standardized procedures under general anesthesia. The recipient cornea trephination diameter was 7 to 8 mm and the donor corneal diameter was the same or 0.25 mm larger than that of the recipient’s. The graft was sutured to the recipient bed with 16 interrupted 10–0 nylon sutures. At the end of the surgery, intraoperative adjustment of sutures was performed to minimize the risk of corneal astigmatism. Pressure patch was applied for 3 to 5 days until epithelial defects are healed.
Postoperatively, topical 0.5% levofloxacin (Cravit, Santen Pharmaceutical, Osaka, Japan) and topical 1% prednisolone acetate (PredForte, Allergan, Irvine, California) were applied four times a day. Topical antibiotics were gradually tapered and maintained for 1 year. Topical steroids were also tapered and maintained for 2 years. Increased intraocular pressure was managed with glaucoma medication and topical 1% prednisolone was switched to topical 0.5% loteprednol (Lotemax, Bausch & Lomb, Rochester, New York) in each patient as needed. Patients were instructed to use 0.1% hyaluronic acid artificial tears for dry eye management, as necessary.

Totally 80 T2DM patients and 150 non-diabetic controls were consecutively recruited from January to June in 2019. The inclusion criteria were T2DM patients with a controlled and stable blood glucose (fasting blood-glucose <8.3 mmol/L or HbA1c level ≤ 7%), and free of systemic administration or topical use of eyedrops for at least 3 months prior to their initial visit. They were further divided into two subgroups according to the duration of diabetes (<15 vs. ≥15 years). All participants are among Han ethic group and are from eastern China. The exclusion criteria were patients with histories of lacrimal or blepharal diseases, corneal or conjunctival disorders, glaucoma, contact lens wearing, history of eye surgeries or with other systematic diseases other than T2DM.
Among these patients, T2DM and non-diabetic controls who were scheduled for cataract surgeries were further followed up twice: one after 3 days of topical application of 0.5% levofloxacin preoperatively (Cravit, Santen, Japan; three times a day), and the other at 7 days after ceasing all postoperative medications of cataract surgery, including 0.5% levofloxacin three times a day for 2 weeks, 1% Prednisolone acetate ophthalmic suspension (Pred Forte, Allergan, Ireland) three times a day for 2 weeks, and Diclofenac sodium eye drops (Difei, Sinqi, China) three times a day for 4 weeks.