Correlation Between Preoperative Aqueous Cytokine Levels and Mid-term Reduction of Corneal Endothelial Cells After Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To investigate the association between preoperative aqueous humor (AqH) cytokines and mid-term endothelial cell density (ECD) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This prospective study included 80 eyes: 47 eyes undergoing DSAEK and 33 cataract surgery eyes as controls. AqH samples were collected at the beginning of surgery. The levels of cytokines [interleukins (ILs)-1α, -1β, -4, -6, -8, -10, -12p70, -17A, monocyte chemotactic protein-1, interferon-α, IFN-γ, E-selectin, P-selectin, and soluble intercellular adhesion molecule-1 (sICAM-1)] in the AqH were measured using a multiplex beads immunoassay. Total protein levels in the AqH were measured independently using the detergent compatible (DC) Protein Assay. DSAEK subjects were divided into 2 groups by 36 months ECD: group 1 (ECD <1200 cells/mm 2 or graft failure, n = 29 eyes) and group 2 (ECD ≥1200, n = 18 eyes). Results: The ECD reduction per year was significantly correlated with preoperative levels of total protein (r = 0.44; P = 0.002) and sICAM-1 (r = 0.46; P = 0.002). Group 1 exhibited significantly higher levels of sICAM-1 compared with group 2 ( P = 0.001). Although not statistically significant, trends were observed between graft failure and levels of total protein ( P = 0.003), IL-17A ( P = 0.04), and sICAM-1 ( P = 0.003). Conclusions: Elevated AqH levels of total protein and sICAM-1 are associated with mid-term ECD reduction and graft failure after DSAEK. Pathological alterations of the AqH microenvironment may critically affect corneal endothelial cells and graft survival after DSAEK.