Longitudinal Anterior Segment Optical Coherence Tomography Imaging Findings After Cultured Human Corneal Endothelial Cell Injection Therapy (Vyznova) for Bullous Keratopathy: Twelve-Month Outcomes in Uncomplicated and Complicated Cases

Purpose: To characterize longitudinal anterior segment optical coherence tomography (AS-OCT) parameters after cultured human corneal endothelial cell (cHCEC) injection therapy (Vyznova) for bullous keratopathy (BK). Methods: This retrospective case series included 4 eyes of 4 consecutive patients with BK (mean age, 76.8 years) treated with cHCEC injection at 3 Japanese institutions. AS-OCT examinations (CASIA2) were performed preoperatively and at 6 and 12 months postoperatively. AS-OCT parameters included central corneal thickness (CCT), posterior stromal ripples (PSR), isopach contour regularity (score: 0–2), and posterior surface depression (PSD). Visual acuity and endothelial cell density (ECD) were evaluated. Results: In 3 uncomplicated cases, mean CCT decreased from 727 μm preoperatively to 537 μm at 12 months. PSR resolved completely by 6 months in all cases. Mean isopach score improved from 0 to 2.0 at 6 months and remained stable through 12 months. Mean PSD improved from −83 μm to −36 μm at 12 months. Mean ECD was 2088 cells/mm 2 at 12 months. One complicated case with intraoperative Descemet membrane detachment demonstrated persistently elevated CCT (686 μm at 12 months), worsening PSD (−182 μm), unchanged isopach score (0), and lower ECD (1041 cells/mm 2 ) despite relative slit-lamp clarity. Conclusions: AS-OCT parameters showed characteristic patterns after cHCEC injection therapy, with early establishment by 6 months and stability through 12 months in uncomplicated cases. A complicated case demonstrated persistent AS-OCT abnormalities despite clinical transparency, suggesting these objective metrics may detect subclinical edema and facilitate postoperative monitoring.