Development of intracellular dark endothelial spots after endothelial keratoplasty in Fuchs endothelial corneal dystrophy is associated with preoperative aqueous humor levels of protein and interleukin-1β

Abstract

Purpose : Intracellular dark endothelial spots (IDES) as imaged by specular microscopy are observed in various conditions, such as ICE syndrome, uveitis, diabetes mellitus and eyes after corneal transplantation. However, the clinical relevance is unclear. We investigated the incidence of IDES after Descemet stripping automated endothelial keratoplasty (DSAEK) in Fuchs endothelial corneal dystrophy (FECD) and assessed the correlation among IDES development, aqueous humor (AqH) levels of protein/cytokines, and endothelial cell density (ECD) after DSAEK.

Methods : This study included 83 eyes (42 healthy controls and 41 patients with FECD [20 underwent cataract surgery and 21 underwent DSAEK], 53 women and 30 men, 73.6±8.7 years, follow-up period 44.0±27.6 months). Among 21 DSAEK procedures, 11 patients (52.4%) developed IDES after DSAEK. The presence of IDES and ECD after DSAEK during the follow-up period was determined using specular microscopy. Preoperative AqH cytokine levels (IL-1β, -6, -8, -10, MCP-1, P-selectin, sICAM-1, and IFN-γ) were measured using multiplex immunoassay.

Results : Central corneal thickness was significantly greater in patients with FECD undergoing DSAEK compared to healthy controls and patients with FECD undergoing solitary cataract surgery (P<0.001). The donor age was significantly younger in the eyes without IDES after DSAEK (52.4±6.3 years), compared to those with IDES (60.8±8.7, P=0.030); however, there were no significant differences in pre- and postoperative ECD, visual acuity, and graft survival rates between the eyes with and without IDES, although the eyes without IDES had a trend of higher ECD (i.e., 1686±331 vs 1120±467 at 36 months, p=0.058). The AqH levels of protein and IL-1β were significantly higher in the eyes with IDES after DSAEK, compared to those without (P=0.021 and P=0.034, respectively). The AqH level of IL-6 was significantly higher in FECD patients undergoing DSAEK compared to healthy controls and FECD patientss undergoing cataract surgery (P<0.01). There were no significant differences in AqH levels of the other cytokines among the groups.

Conclusions : In FECD, eye with IDES after DSAEK may develop in eyes receiving grafts from elder donors and have a trend of greater ECD loss.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.