Aqueous Cytokine Levels Are AssociatedWith Progression of Peripheral Anterior Synechiae After Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To evaluate the association between total protein and cytokine levels in aqueous humor (AqH) and the progression of peripheral anterior synechiae (PAS) after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This prospective study included 146 consecutive patients who underwent DSAEK. Preoperative levels of total protein and 20 cytokines in AqH were measured. Using three-dimensional anterior segment optical coherence tomography, we assessed the iridotrabecular contact (ITC) area before and at 3, 6, and 12 months after DSAEK. Correlations between the total protein and cytokine levels in the AqH and ITC area were analyzed. Results: ITC was observed in 47 eyes (32.2%) after DSAEK. The ITC area increased from 2.00 +/- 4.42 mm(2) preoperatively to 3.00 +/- 6.85 mm(2) at 12 months. The total protein level in AqH was significantly higher in eyes with ITC progression than in those without (1.45 +/- 1.03 mg/mL vs. 1.00 +/- 0.57; P = 0.04) and was significantly positively correlated with the progression of ITC area after DSAEK (at 6 months, r = 0.311 and P = 0.005; at 12 months, r= 0.342 and P= 0.0004). The ITC area at 12months was significantly correlated with the preoperative AqH levels of interleukin-8 (r= 0.252; P= 0.021), interferon gamma (r = 0.318; P = 0.009), and soluble intercellular adhesion molecule-1 (r = 0.292; P = 0.004). Multivariate analyses showed that the total protein levels in AqH and the presence of preoperative ITC were significant risk factors for increased ITC area after DSAEK (beta = 0.193-0.574; all P < 0.02). Conclusions: Higher preoperative total protein and specific cytokine levels in AqHwere associated with ITC formation after DSAEK. Translational Relevance: Our findings indicate that chronic pathological changes in AqH can cause PAS progression and glaucoma after DSAEK.