title: Blood-aqueous barrier breakdown after penetrating keratoplasty with simultaneous extracapsular cataract extraction and posterior chamber lens implantation.
abstract: BACKGROUND
  The purpose of this study was to quantify breakdown of the blood-aqueous barrier (BAB) following penetrating keratoplasty (PK) with simultaneous extracapsular cataract extraction and posterior chamber lens implantation (triple procedure) and compare it with the alterations following PK only.
  
  
  METHODS
  This study included 72 eyes after triple procedure and 227 eyes after PK only. The diagnosis for PK was Fuchs dystrophy in 39%, keratokonus in 44%, stromal corneal dystrophy in 3% and avascular corneal scars in 6% of cases. The postoperative topical steroid treatment was standardized in both groups. Aqueous flare was quantified using the laser flare-cell meter (FC-1000, Kowa) at defined postoperative intervals (10 days, 6 weeks, then every 3 months until 1 year postoperatively). Patients with conditions associated with impairment of the BAB were excluded from the study.
  
  
  RESULTS
  In the early postoperative course, aqueous flare values (photon counts/ms) were significantly higher in patients with triple procedure (21.9 +/- 11.0) than in patients with PK only (9.8 +/- 3.2; P = 0.001). At 6 weeks postoperatively, aqueous flare returned to normal levels in patients after PK only (5.2 +/- 2.3), whereas patients with triple procedure still showed significantly increased flare values (10.8 +/- 5.6; P = 0.01). At 6 months postoperatively, aqueous flare values of patients with triple had returned to normal levels (6.8 +/- 3.8) and did not differ significantly from those after PK only (5.2 +/- 1.9; P = 0.09).
  
  
  CONCLUSIONS
  Our results indicate that triple procedure causes a more extensive and longer-lasting breakdown of the blood-aqueous barrier than PK only. Quantification of aqueous flare with the laser flare-cell meter is useful in the postoperative follow-up after triple procedure. Further studies are required to investigate the clinical relevance of BAB breakdown on endothelial cell count and the incidence of subsequent immunological graft rejection.
authors.affiliation: Department of Ophthalmology and University Eye Hospital, Schwabachanlage 6, University Erlangen-Nürnberg, 91054 Erlangen, Germany. nhung.nguyen@augen.imed.uni-erlangen.de
authors.forename: N X
authors.initials: NX
authors.lastname: Nguyen
authors.forename: A
authors.initials: A
authors.lastname: Langenbucher
authors.forename: B
authors.initials: B
authors.lastname: Seitz
authors.forename: M
authors.initials: M
authors.lastname: Graupner
authors.forename: C
authors.initials: C
authors.lastname: Cursiefen
authors.forename: M
authors.initials: M
authors.lastname: Küchle
authors.forename: G O
authors.initials: GO
authors.lastname: Naumann
mesh_terms: D001082:Aqueous Humor / Q000166:cytology*; D018916:Blood-Aqueous Barrier; D002199:Capillary Permeability; D002387:Cataract Extraction / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D014606:Uveitis, Anterior / Q000209:etiology* / Q000503:physiopathology