Corneal biomechanical changes in patients with anterior chamber inflammation: a systematic review and meta-analysis

Purpose: Anterior chamber inflammation (ACI) causes corneal changes like band keratopathy, reduced endothelial cell density, and increased central corneal thickness (CCT). This review analyzes ACI’s impact on corneal biomechanics. Methods: Registered in PROSPERO (CRD42024584649) following PRISMA guidelines, systematic searches were conducted in PubMed, Embase, Virtual Health Library, and MedXRiv (May 2, 2024). Studies with ≥ 10 ACI patients were included. Data on corneal hysteresis (CH), corneal resistance factor (CRF), CCT, intraocular pressure (IOP): corneal-compensated (IOPcc) and Goldmann-correlated (IOPg) were extracted. Meta-analyses assessed mean differences and heterogeneity (I²), with sensitivity analyses for outliers and moderators (age, CCT). The Mann-Whitney U Test compared age, CCT, IOPg, and IOPcc between groups. Results: Three studies comprising 126 ACI patients and 112 healthy controls were included. No significant differences were found between ACI patients and controls in age or CCT (p > 0.05). Meta-analyses revealed significant reductions in CH (-1.06 mmHg, 95% CI: -2.03 to -0.09, I²=83%) and CRF (-1.59 mmHg, 95% CI: -2.35 to -0.84, I²=69%) in ACI patients compared to controls. Sensitivity analysis showed that CCT as a moderator explained all the heterogeneity (R²=100%), while age did not (R²=0%). IOPg and IOPcc did not significantly differ among ACI patients (p = 0.051). Conclusion: Patients with ACI exhibit significant reductions in corneal biomechanical properties (CH and CRF), with CRF consistently lower across all age groups. CCT significantly impacts corneal biomechanics, potentially making biomechanics alterations more evident during remission states.