Impact of Diabetic Donor Grafts in Descemet Membrane Endothelial Keratoplasty

To investigate the impact of donor diabetes mellitus on donor corneal tissue in organ culture on graft preparation, surgical outcomes, and graft survival.

Retrospective comparison of 273 eyes (218 patients) undergoing DMEK, divided into 2 subgroups [0: donor without diabetes (n = 210); D: donor with diabetes (n = 63)]. The data of visual acuity (VA), central corneal thickness (CCT) and endothelial cell count (ECC), and intra- and postoperative complications were collected.

Donor ECC was comparable in both groups (group 0: 2618 ± 183 cells/mm 2 vs. group D 2556 ± 218 cells/mm 2 ; P = 1.0). Preparation was slightly more difficult in group D (25% vs. 20%; P = 0.45), as peripheral tears occurred more frequently (25% vs. 16%; P = 0.08), however, these donors were also significantly more frequently already pseudophakic (59% vs. 35%; P = 0.001). The scrolling behavior of the graft and the intraoperative difficulties in the anterior chamber were comparable in both groups. Preparation time and difficulties during preparation or implantation had no significant influence on postoperative rate of rebubbling or repeat DMEK in either group (all P > 0.05). The postoperative outcome was comparable regarding VA, CCT and ECC, rebubbling rate (40% both groups; P = 0.99) and repeat DMEK (group 0: 6% vs. group D: 9%; P = 0.57) during 12-month follow-up.

We could not demonstrate any significant differences in graft preparation using the liquid-bubble technique in organ culture conditions, nor in postoperative outcomes after DMEK, between corneas from diabetic and nondiabetic donors. However, further prospective research is needed to fully understand the impact of diabetes on corneal transplantation.