Aqueous flare dynamics following penetrating, anterior lamellar, and endothelial corneal transplantation: Quantitative comparison and early complication detection

Background: To noninvasively quantify postoperative anterior chamber inflammation following corneal transplantation using Laser Flare Photometry (LFP), and to compare flare dynamics among three surgical techniques: deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK, including triple procedures), and penetrating keratoplasty (PK, including combined procedures). Particular attention was given to the incidence of cystoid macular oedema (CMO) and early immune-mediated graft reactions. The study also aimed to explore the role of LFP as a biomarker for individualised inflammatory risk stratification. Methods: In this retrospective observational cohort study, 60 eyes of 60 patients who underwent corneal transplantation were allocated into three groups: DALK (n = 18), DSAEK (n = 24), and PK (n = 18). Aqueous flare was measured using LFP at baseline and on postoperative days 1, 7, 30, and 90. Primary outcomes included flare kinetics, surgical duration, CMO occurrence, and early signs of graft rejection. Results: Mean aqueous flare peaked on day 1 in all groups: 50.9 ± 42.6 ph/ms in DALK, 70.0 ± 46.4 in DSAEK, and 79.0 ± 55.6 in PK. By day 90, flare returned near baseline in DALK (10.0 ± 4.7), while remaining mildly elevated in DSAEK (11.1 ± 10.0) and PK (12.8 ± 7.9). CMO developed in 5 eyes (1 DALK, 2 PK), and early graft reactions in 6 eyes (1 DALK, 3 DSAEK, 2 PK). Conclusions: This study highlights distinct inflammatory trajectories after corneal transplantation. LFP may serve as a valuable, non-invasive tool to monitor inflammation, guide personalised immunosuppression and prevent graft failure.