DMEK graft preparation from diabetic donors more likely to fail

This retrospective study found that Descemet membrane endothelial keratoplasty (DMEK) graft preparation may be more likely to fail when the donor has a history of diabetes. The authors recommend caution in the use of diabetic tissue for DMEK grafts and avoidance of such tissue whenever possible.

They analyzed retrospectively graft preparation failure rates in 359 corneas from 290 donors (114 diabetic and 245 nondiabetic) prepared for DMEK. Grafts were prepared by experienced technicians at two eye banks using slightly different, modified submerged manual preparation techniques to achieve “prestripped” graft tissue. Unsuccessful graft preparation (failure) was defined as the occurrence of a tear while separating the endothelial cell-Descemet membrane monolayer from the stroma that rendered the tissue unusable for transplantation.

They found a statistically significant increased risk of DMEK preparation failure in diabetic (15.3%) versus nondiabetic (1.9%) patients. There was a nine-fold increase in the odds of DMEK graft processing failure with tissue from a diabetic donor compared to a nondiabetic donor.

The authors believe that the strong association between tissue preparation failure and diabetes represents a functional manifestation of molecular alterations because of chronic hyperglycemia involving Descemet membrane and its zone of attachment with the posterior stroma. They say that even when successful, preparation of tissue from donors with a history of diabetes may be more difficult and may have implications on subsequent graft survival that warrant further investigation.