Anterior Chamber Inflammation and Descemet Membrane Endothelial Keratoplasty

PURPOSE To assess anterior chamber (AC) subclinical inflammation using a noninvasive method in patients undergoing Descemet membrane endothelial keratoplasty (DMEK). DESIGN Retrospective interventional case series. PARTICIPANTS This study included 83 eyes from 73 patients who underwent DMEK surgery and 15 control eyes from 15 healthy subjects. METHODS The number of hyper-reflective dots representing AC cells and optical density ratio (aqueous-to-air relative intensity [ARI] index) for flare quantification were calculated from AS-OCT images. ARI index and AC cells were calculated preoperatively (T0) and postoperatively at one week (T1), one month (T2), and three months (T3) after DMEK surgery. Baseline values were compared with a healthy control group. Main Outcome Measures AC cell count and ARI index over time; association with postoperative posterior stromal ripples (PSR) and rebubbling. Results Baseline ARI index was significantly higher in the DMEK group compared with controls, whereas no significant difference in AC cell count was observed. AC 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 < .001), to 1.7 (1.1–3.0) at T2 (P = .03) and to 2.1 (1.1–4.2) at T3 (P = .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 < .001) and 114.4 (101.7–140.7) at T2 (P < .001). Higher ARI at T1 was weakly associated with postoperative PSR (OR = 1.63, 95% CI [1.00–2.67], P = .048), whereas postoperative PSR were strongly associated with rebubbling (OR = 26.00, 95% CI [3.20–211.18], P = .002). CONCLUSIONS AS-OCT enables noninvasive detection of subclinical inflammation following DMEK surgery. The presence of markers of inflammation can increase the risk of early postoperative complications.