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

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 individuals. Methods: 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. Main Outcome Measures: Anterior chamber cell count and ARI index over time; association with postoperative posterior stromal ripples (PSRs) 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. 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). Conclusions: 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. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.