Numerous animal and human studies have suggested that the corneal endothelium is adversely affected by diabetes mellitus biochemically, morphologically, functionally, and following cataract surgery. Despite this literature, until recently there have been virtually no studies on the effects of diabetes in cornea donors on graft outcome and cell loss following keratoplasty. Three developments recently have called greater attention to the effect of diabetes in the donor on transplant success:

• The explosion of diabetes in the population
• Two recent papers have raised concern that donor preparation for Descemet membrane endothelial keratoplasty (DMEK) is at more risk for failure when donors have diabetes, prompting some eye banks to no longer use donors with diabetes for DMEK preparations
• There is growth of DMEK in the past few years as the endothelial keratoplasty procedure for endothelial failure conditions because of its visual results and lower rejection rate as compared with penetrating keratoplasty (PKP) and Descemet-stripping automated endothelial keratoplasty (DSAEK).

This video reviews this background and presents findings from the Cornea Donor Study, a recent review of this cohort focusing on the effect of donor and recipient diabetes on transplant success and cell loss following PKP, and a study by Vislisel et al. following DSAEK. Neither study found a diabetic effect with donors with or without diabetes. Both studies, however, were limited in that diabetes was determined simply by history, and the studies did not look at diabetes control or diabetes complications affecting transplant outcome. The Cornea Preservation Time Study (CPTS) also provides information on this question in a large cohort of patients undergoing DSAEK. Recommendations for the current approach to managing the use of donors with diabetes for PKP, DSAEK, and DMEK, as well as next steps to study this question, are also made.