BARCELONA — Donor diabetes significantly affects preparation of the Descemet’s membrane endothelial keratoplasty graft, but has no impact on graft survival rate or endothelial cell count, according to a study.
With the rising prevalence of diabetes worldwide, an increasing number of donor corneas are likely to come from individuals with diabetes.
Francis W. Price Jr.
“The U.S. bank data show us that 30% of our donors are diabetics and this is probably an underestimation because about a quarter of the diabetics are currently undiagnosed,” OSN Cornea/External Disease Board Member Francis W. Price Jr, MD, said at the EuCornea meeting.
Diabetes affects the capillary basement membrane and consequently changes at the Descemet’s level may be responsible for the difficulties that are commonly experienced during preparation.
“The Descemet membrane is more brittle, with more adhesions and more prone to tears,” Price said.
In a review of 1,310 DMEK cases, preparation failure rate was 0.7% in nondiabetic donors and 6.6% in diabetic donors. However, diabetes did not affect DMEK graft survival rate or endothelial cell count.
“There is a limitation in our study and other similar studies. The eye banks use simplistic methods to diagnose diabetes, based on limited medical history with no information on type of treatment, duration of diabetes or level of glycemic control,” Price said.
He mentioned the case of a DMEK graft from a donor with early stage diabetes, which was easy to prepare and presented no alterations in Descemet’s membrane.
“We cannot exclude all diabetic donors from DMEK, but need better ways to characterize the donor diabetes,” Price concluded. — by Michela Cimberle
Disclosure: Price reports no relevant financial disclosures.