Aqueous Cytokine Levels are Associated with Progression of Peripheral Anterior Synechiae after Descemet Stripping Automated Endothelial Keratoplasty

Glaucoma is a serious complication after corneal transplantation that can lead to permanent loss of vision. Peripheral anterior synechiae (PAS) leads to severe glaucoma, which is refractory to medications, however, the exact mechanism of PAS development after corneal transplantation is still elusive. Recent studies revealed significant alterations in cytokine levels in aqueous humor (AqH) in glaucoma. Hence, we quantified PAS area using three dimensional OCT and evaluated the association between cytokine levels in AqH and PAS area after Descemet stripping automated endothelial keratoplasty (DSAEK). We first found that the total protein level in AqH was significantly higher in eyes with PAS progression than those without, and was positively correlated with the progression of PAS area after DSAEK. Furthermore, the postoperative PAS area was significantly correlated with the AqH levels of interleukin-8, interferon-γ, and soluble intercellular adhesion molecule-1. Multivariate analyses showed that the total protein levels in AqH and presence of preoperative PAS were significant risk factors for increased PAS area after DSAEK. The PAS development was associated with intraocular pressure increase after DSAEK. In conclusion, these findings suggest that pathological alterations in the AqH can cause PAS progression and glaucoma after DSAEK.