Long-Term Monitoring of Corneal Grafts Via Anterior Segment OCT Pachymetry Maps

To assess the efficacy of anterior segment OCT (AS-OCT) in the long-term monitoring of corneal grafts and its integration into a hybrid remote care model for early detection and management of graft rejection or failure.

Prospective cohort study.

Seventy-four patients (93 eyes) who underwent corneal transplantation from October 2021 to December 2023, with a follow-up period of ≥6 months.

Serial AS-OCT pachymetry maps and cross-sectional scans were performed at fixed postoperative intervals, and the findings were correlated with clinical signs of graft rejection or failure on slit lamp examination for thickness changes >50 μm. A hybrid remote AS-OCT screening protocol was initiated 1 week postoperatively.

Diagnostic accuracy of AS-OCT, measured by specificity and sensitivity, in detecting graft rejection or failure through changes in corneal and graft thickness.

Anterior segment OCT demonstrated high diagnostic accuracy with a specificity of 97.6% and a sensitivity of 88.9% in detecting graft rejection or failure. The mean central corneal thickness increase in cases resulting in graft rejection or failure was 82.7 ± 21.5 μm, a thickness change that is not discernible by slit lamp examination alone. The utility of AS-OCT in a hybrid remote monitoring model was demonstrated through 3 detailed case studies, highlighting improved clinical workflow and patient convenience without compromising postoperative outcomes.

Serial AS-OCT imaging serves as a robust, objective, and quantitative tool for postoperative surveillance of corneal grafts, significantly benefiting patient outcomes by allowing timely interventions. Integration of AS-OCT into a hybrid remote screening protocol supports comprehensive monitoring, complementing direct clinical evaluations and optimizing postoperative care.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.