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Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty
Husna Topcu1, Burcin Kepez Yildiz2, Yusuf Yildirim2
1Department of Ophthalmology, Inebolu State Hospital, Kastamonu, Turkey.
Insights
Systemic diseases like diabetes mellitus negatively impact Descemet membrane endothelial keratoplasty outcomes. Diabetes in recipients significantly disrupted graft attachment, highlighting recipient health as a key factor in surgical success.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Corneal Surgery
Background:
- Descemet membrane endothelial keratoplasty (DMEK) is a surgical procedure for endothelial dysfunction.
- Systemic diseases in patients may influence the anatomical outcomes of DMEK.
- Understanding factors affecting graft attachment is crucial for improving DMEK success rates.
Purpose of the Study:
- To investigate the association between anatomical outcomes of DMEK and patient medications.
- To evaluate the impact of donor factors on DMEK anatomical outcomes in patients with systemic diseases.
Main Methods:
- Retrospective study of 60 non-diabetic donors and 60 patients undergoing DMEK.
- Collected patient data: diabetes mellitus, hypertension, medications, tamponades, and outcomes.
- Analyzed donor data: age, sex, cause of death, endothelial cell count.
Main Results:
- Diabetes mellitus was present in 30% of patients; hypertension in 56.6%.
- Graft attachment occurred in 58.3% of patients; 13.3% required reinjection.
- Recipient diabetes mellitus significantly disrupted graft attachment (p=0.034); donor factors and other patient comorbidities did not show statistical significance.
Conclusions:
- Anatomical outcomes of DMEK are influenced by both recipient and donor factors.
- Recipient diabetes mellitus is a significant negative predictor of graft attachment after DMEK.
- Further research may explore strategies to mitigate the impact of diabetes on DMEK success.
Purpose:
The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors.
Methods:
Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records.
Results:
Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05).
Conclusion:
In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.
