Long-Term Monitoring of Corneal Grafts Via Anterior Segment OCT Pachymetry Maps.

Purpose: To assess the efficacy of anterior segment OCT (AS-OCT) in the long-term monitoring of corneal grafts and its integration into a hybrid remote care model for early detection and management of graft rejection or failure. Design: Prospective cohort study. Participants: Seventy-four patients (93 eyes) who underwent corneal transplantation from October 2021 to December 2023, with a follow-up period of ≥6 months. Methods: Serial AS-OCT pachymetry maps and cross-sectional scans were performed at fixed postoperative intervals, and the findings were correlated with clinical signs of graft rejection or failure on slit lamp examination for thickness changes >50 μm. A hybrid remote AS-OCT screening protocol was initiated 1 week postoperatively. Main Outcome Measures: Diagnostic accuracy of AS-OCT, measured by specificity and sensitivity, in detecting graft rejection or failure through changes in corneal and graft thickness. Results: Anterior segment OCT demonstrated high diagnostic accuracy with a specificity of 97.6% and a sensitivity of 88.9% in detecting graft rejection or failure. The mean central corneal thickness increase in cases resulting in graft rejection or failure was 82.7 ± 21.5 μm, a thickness change that is not discernible by slit lamp examination alone. The utility of AS-OCT in a hybrid remote monitoring model was demonstrated through 3 detailed case studies, highlighting improved clinical workflow and patient convenience without compromising postoperative outcomes. Conclusions: Serial AS-OCT imaging serves as a robust, objective, and quantitative tool for postoperative surveillance of corneal grafts, significantly benefiting patient outcomes by allowing timely interventions. Integration of AS-OCT into a hybrid remote screening protocol supports comprehensive monitoring, complementing direct clinical evaluations and optimizing postoperative care. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.