Correlation Between Preoperative Aqueous Cytokine Levels And Mild-Term Reduction Of Corneal Endothelial Cells Following Descemet Stripping Automated Endothelial Keratoplasty

To investigate the association between preoperative cytokine levels in the aqueous humor (AqH), previous cataract surgery, and corneal endothelial cell density (ECD) 3 years after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK).

This prospective study enrolled consecutive patients who underwent DSAEK at Tokyo Dental College, Ichikawa General Hospital  between October 2015 and January 2019. Control patients were defined as those who underwent uneventful cataract surgery without any prior ocular diseases or intraocular surgeries. The study was conducted in accordance with the tenets of the Declaration of Helsinki and was approved by the Institutional Ethics Review Board of Tokyo Dental College, Ichikawa General Hospital.

The study included 80 eyes, comprising 47 eyes in the DSAEK group and 33 control eyes in the cataract surgery group. The DSAEK group was further divided into two subgroups based on ECD: Group 1 with ECD <1200 cells/mm² or endothelial failure at 3 years after DSAEK (n=29), and Group 2 with ECD >1200 cells/mm² (n=18). In the DSAEK group, 15 eyes underwent simultaneous catarct surgery combined with DSAEK, while 32 eyes underwent solitary DSAEK. Preoperative AqH cytokines were measured using Luminex, and multivariate analyses were performed to identify associations between ECD, previous cataract surgery, and various clinical factors.

Levels of sICAM-1 were significantly higher in patients who underwent cataract surgery before DSAEK compared to those who did not (P < 0.05). Additionally, IL-1α, IL-4, IL-6, IL-8, IL-12p70, IL-17A, MIP-1β, MCP-1, IFN-α, IFN-γ, E-selectin, and P-selectin levels were significantly higher in the DSAEK group compared to the control group (P < 0.05). Several cytokines showed significant increases in correlation with iris damage, glaucoma, DSAEK history, and graft failure (P < 0.05). There was a significant difference between the annual rate of ECD reduction and levels of sICAM-1 (P = 0.0071). Furthermore, significant differences in sICAM-1 levels were observed between different etiologies of DSAEK.

Elevated cytokine levels in the AqH were associated with a rapid decrease in ECD after DSAEK. Significant correlations were found between cytokine levels in the AqH and various clinical factors. The observed association between sICAM-1 levels and the rate of ECD reduction, along with differences between phakic and pseudophakic groups, suggests that prior cataract surgery may affects corneal endothelial cell survival after DSAEK.