Preoperative cytokine levels in aqueous humor and prognosis of corneal transplantation in bullous keratopathy following glaucoma filtration surgery

Abstract

Purpose : To evaluate preoperative inflammatory cytokine levels in the aqueous humor (AqH) and prognosis of penetrating keratoplasty (PKP) or endothelial keratoplasty (EK) for the treatment of bullous keratopathy following glaucoma filtration surgery.

Methods : This study includes 29 consecutive patients (mean age 71.7 ± 10.8), who underwent PKP (6 eyes) or EK (23 eyes) or 33 controls undergoing uncomplicated cataract surgery. A total of 62 AqH samples were collected at the beginning of each surgery. The levels of cytokines (interleukin [IL]-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, interferon [IFN]-α, IFN-γ, monocyte chemotactic protein [MCP]-1, E-selectin and P-selectin) in AqH were measured by multiplex beads immunoassay. The subjects who underwent PKP or EK were classified into two groups: the presence of graft endothelial dysfunction (10 eyes) and absence of graft endothelial dysfunction (19 eyes) during the follow up.

Results : Endothelial cell density (ECD) significantly decreased from 2799±239 cells/mm² (graft) to 1904±538 at 1 month, 1491±835 at 3 months, 1220±735 at 6 months, 777±478 at 12 months and 524±395 at 24 months (all, p< 0.0001). The preoperative levels of protein, IL-4, IL-6, IL-8, IL-10, IL-17a, IFN-γ, MCP-1, sICAM-1, E-selectin and P-selectin in AqH were significantly higher in eyes undergoing corneal transplantation compared to the controls (all, P < 0.0025). The graft survival rate was 73.8% at 12 months and 55.4% at 24 months. When comparing between the eyes with or without graft endothelial failure after corneal transplantation during the follow-up period, the preoperative cytokine levels were higher in eyes with graft failure than those without graft failure (i.e.., protein: 2.02 ± 0.43 mg/mL in eyes with graft failure, 1.27 ±0.18 in eyes without graft failure, and 0.31±0.05 in controls, IL-10: 16.5±11.6 pg/mL in eyes with graft failure, 3.2±0.6 in eyes without graft failure and 1.8±0.1 in controls, sICAM-1: 9204±2230 pg/mL in eyes with graft failure, 6696±1376 in eyes without graft failure, and 2027±450 in controls). However, there were no statistical differences in preoperative cytokine levels in AqH between the groups.

Conclusions : Preoperative cytokine levels in AqH were significantly higher in eyes with bullous keratopathy following glaucoma filtration surgery than cataract controls.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.