Anterior Chamber Inflammation and Descemet Membrane Endothelial Keratoplasty: An Anterior Segment-OCT-Based Analysis

To assess anterior chamber (AC) subclinical inflammation using a noninvasive method in patients undergoing Descemet membrane endothelial keratoplasty (DMEK).

Retrospective interventional case series.

This study included 83 eyes from 73 patients who underwent DMEK surgery and 15 control eyes from 15 healthy individuals.

The number of hyperreflective dots representing AC cells and optical density ratio (aqueous-to-air relative intensity [ARI] index) for flare quantification were calculated from anterior segment-OCT images. Aqueous-to-air relative intensity index and AC cells were calculated preoperatively and postoperatively at 1 week (T1), 1 month (T2), and 3 months (T3) after DMEK surgery. Baseline values were compared with a healthy control group.

Anterior chamber cell count and ARI index over time; association with postoperative posterior stromal ripples (PSRs) and rebubbling.

Baseline ARI index was significantly higher in the DMEK group compared with controls, whereas no significant difference in AC cell count was observed. Anterior chamber cell count increased postoperatively from a median of 1.1 cells (0.6-2.1) at baseline to 3.5 (1.7-5.3) at T1 (P < 0.001), to 1.7 (1.1-3.0) at T2 (P = 0.03), and to 2.1 (1.1-4.2) at T3 (P = 0.01). The ARI index also increased from a median of 98.3 (84.1-121.9) at baseline to 142.8 (119.8-221.3) at T1 (P < 0.001) and 114.4 (101.7-140.7) at T2 (P < 0.001). Higher ARI at T1 was weakly associated with postoperative PSR (odds ratio [OR] = 1.63; 95% confidence interval [CI], 1.00-2.67; P = 0.048), whereas postoperative PSR were strongly associated with rebubbling (OR = 26.00; 95% CI, 3.20-211.18; P = 0.002).

Anterior segment-OCT enables noninvasive detection of subclinical inflammation after DMEK surgery. The presence of markers of inflammation can increase the risk of early postoperative complications.

The authors have no proprietary or commercial interest in any materials discussed in this article.