Aqueous Humor Total Protein Levels Predict 6-Year Graft Survival after Endothelial Keratoplasty in…

Cohort studyOphthalmology science· Jul 2026

Aqueous Humor Total Protein Levels Predict 6-Year Graft Survival after Endothelial Keratoplasty in Surgically Treated Glaucoma Eyes.

Sayaka Kaneko, Yukari Yagi-Yaguchi, Taiyo Shijo … Takefumi Yamaguchi

Transplant SurgeryCohort studyPrognosisQ1IF 5.5

High preoperative aqueous protein linked to 0% 6-year graft survival after keratoplasty

Aqueous Humor Total Protein Levels Predict 6-Year Graft Survival after Endothelial Keratoplasty in Surgically Treated Glaucoma Eyes.

Sayaka Kaneko … Takefumi Yamaguchi

Ophthalmology science · Jul 2026

Purpose

To evaluate the association between endothelial graft failure and total protein levels in the aqueous humor (aqueous humor) after Descemet stripping automated endothelial keratoplasty (descemet stripping automated endothelial keratoplasty) in eyes with surgically treated glaucoma.

Methods

This consecutive case series included 181 patients who underwent descemet stripping automated endothelial keratoplasty and were stratified into 3 groups: no glaucoma (132 eyes), medically treated glaucoma (17 eyes), and surgically treated glaucoma (32 eyes).

n = 181 patients

Results

high aqueous protein before surgery meant every graft failed by 6 years

HR by subgroup · 95% CI

More results

Best-corrected visual acuity significantly improved after descemet stripping automated endothelial keratoplasty in all groups.

More results

However, endothelial cell density after descemet stripping automated endothelial keratoplasty was significantly lower in eye with surgically treated glaucoma, compared to eye without glaucoma ( P < 0.01 at all timepoints up to 6 years).

Graft survival was significantly lower in the surgically treated group ( P < 0.001).

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Conclusion

Higher preoperative total protein levels in aqueous humor were associated with poor graft survival after descemet stripping automated endothelial keratoplasty for bullous keratopathy after glaucoma surgery.