Aqueous Flare Following Penetrating Keratoplasty and in Corneal Graft Rejection

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Abstract
Objective: Corneal allograft rejection is a major complication of penetrating keratoplasty (PK). We used the laser flare-cell meter that allows, for the first time, noninvasive quantification of aqueous flare in vivo to analyze alterations of the blood-aqueous barrier following uncomplicated PK and in acute corneal graft rejection. Patients and Methods: Examination with the laser flarecell meter was performed in 67 eyes of 62 patients (mean±SD age, 46.2±15.1 years) 12.8±13.2 months (range, 5 days to 60 months) after uncomplicated PK, in 82 normal control eyes of 82 age- and gender-matched patients (mean age, 49.0±17.1 years) and in 10 eyes of 10 patients (mean age, 51.6±15.1 years) with acute diffuse endothelial corneal graft rejection in nonherpetic eyes 15.1±12.9 months after PK. Results: Compared with the normal unoperated control group (4.43±1.13 photon counts/ms), aqueous flare was significantly increased during the first 2 weeks following uncomplicated PK (14.73±8.30 photon counts/ms; P<.0001) but returned to normal levels more than 6 weeks after surgery (4.48±1.55 photon counts/ms; P>. 1). In acute corneal graft rejection, aqueous flare values (17.10±6.05 photon counts/ms) increased to significantly higher levels than in eyes following uncomplicated PK and in the normal control group (P<.0001), but decreased significantly 9.5±3.3 days after treatment with systemic and topical corticosteroids (5.78±2.16; P<.0005). Conclusions: Application of the laser flare-cell meter appears promising for following up patients after PK and for detecting early corneal allograft rejection.