Elevated flare may predict later graft rejection

Elevated aqueous flare after penetrating keratoplasty may be associated with later graft rejection, a long-term observational study suggests. The preoperative diagnosis and a history of implant surgery may influence aqueous flare counts in the early postoperative period, according to the study authors.

David Hui-Kang Ma, MD, PhD, and others at Taiwan’s Chang Gung University reviewed the records of 86 eyes of 86 patients who had undergone penetrating keratoplasty (PK) with a follow-up of up to 76 months. PK alone was performed on seven eyes with keratoconus, 19 with corneal scar, 16 with pseudophakic bullous keratopathy and 14 who needed regraft. PK was combined with cataract extraction and IOL implantation in 17 eyes with corneal scar and with IOL exchange in 13 eyes with bullous keratopathy.

Aqueous flare was measured with a laser flare-cell meter at 1 week and 1, 3, 6, 12 and 24 months postoperatively. Follow-up ranged from 7 to 76 months, with an average of 25 months.

Endothelial rejection occurred in 11 cases. Of those, seven cases failed. An additional 10 grafts failed from other causes. At the last follow-up, 69 grafts remained clear, according to the study authors.

There was a significant difference in aqueous flare values among eyes undergoing PK only for keratoconus, corneal scar, pseudophakic bullous keratopathy and regraft from 1 week to 3 months postop. Within the corneal scar group, aqueous flare value was significantly higher from 1 week to 3 months when combined with cataract surgery. In the pseudophakic bullous keratopathy group, the value was significantly higher from 1 week to 1 month and 6 months when combined with anterior chamber-IOL exchange.

The study is published in Cornea.