Aqueous Humor Total Protein Levels Predict 6-Year Graft Survival after Endothelial Keratoplasty in Surgically Treated...

To evaluate the association between endothelial graft failure and total protein levels in the aqueous humor (AqH) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with surgically treated glaucoma.

A prospective case series.

This consecutive case series included 181 patients who underwent DSAEK and were stratified into 3 groups: no glaucoma (132 eyes), medically treated glaucoma (17 eyes), and surgically treated glaucoma (32 eyes). The endothelial cell density (ECD) and graft survival rate was compared among the groups and within the surgically treated glaucoma group, among subgroups stratified by AqH total protein levels. Aqueous humor samples were collected at the beginning of each surgery. The levels of total protein and cytokines (interleukin [IL]-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, interferon-α, interferon-γ, monocyte chemotactic protein-1, E-selectin, P-selectin, and soluble intercellular adhesion molecule-1) in the AqH were measured by a dye-binding assay or multiplex beads immunoassay. The severity of iris damage was graded based on the number of affected quadrants (range, 0-4).

Graft survival over 6 years after DSAEK in relation to preoperative AqH total protein levels and its association with postoperative ECD.

Best-corrected visual acuity significantly improved after DSAEK in all groups. However, ECD after DSAEK was significantly lower in eye with surgically treated glaucoma, compared to eye without glaucoma (P < 0.01 at all timepoints up to 6 years). Graft survival was significantly lower in the surgically treated group (P < 0.001). In Cox proportional hazards model, trabeculectomy (hazard ratio: 2.247, 95% confidence interval: 1.133-4.455, P = 0.020) and iris damage severity (hazard ratio: 1.514, 95% confidence interval: 1.224-1.871, P < 0.001) were identified as independent risk factors for graft failure. In surgically treated glaucoma group, 6-year graft survival was 100% in the low-protein group (<0.7 mg/mL, n = 4), 23% in the medium-protein group (0.7-1.6 mg/mL, n = 17), and 0% in the high-protein group (>1.6 mg/mL, n = 10) (log-rank test, P = 0.0033).

Higher preoperative total protein levels in AqH were associated with poor graft survival after DSAEK for bullous keratopathy after glaucoma surgery.

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