Age-Stratified Analysis of Diabetes and Pseudophakia Effects on Corneal Endothelial Cell Density: A Retrospective Eye Bank Study

Abstract

Purpose To perform an age-stratified analysis of the effect of diabetes and pseudophakia on the corneal endothelial cell density. Methods A comparative analysis of donor characteristics from data supplied by the Lions Eye Institute for Transplant and Research on tissue harvested from July 1st, 2007 through May 23, 2014. The mixed-effects model was used to compare age-adjusted mean corneal endothelial cell density (ECD) between donors with and without diabetes. Results 20,026 non-diabetic donor eyes and 13,617 diabetic donor eyes were included in this study. The ECD was 2,604 cells/mm2 in non-diabetic corneas and 2,576 cells/mm2 in diabetic corneas (p < 0.001). Among phakic patients, diabetic ECD was significantly less in the middle-age subgroups: -33 cells/mm2 in the 21 to 40 year old subgroup (p = 0.048) and -25 cells/mm2 in the 41 to 60 year old subgroup (p = 0.009). Among pseudophakic patients, diabetic ECD was significantly less only in the subgroup 61 years or older: -56 cells/mm2 (p = 0.026). The magnitude of difference in ECD between phakic and pseudophakic donors was greater in diabetic patients in the subgroup 61 years or older (p < 0.001). Conclusion Donor eyes with a history of diabetes had a slightly lower ECD (-29 cells/mm2) than eyes without a history of diabetes. While this statistical relationship is consistent with our pathophysiologic understanding diabetes and the corneal endothelium, such a minor difference in ECD would be expected to have minimal clinical impact on overall corneal endothelial function.

How to Predict the Suitability for Corneal Donorship?

“…The mean ECD values in this study are lower than those obtained in other studies such as Schaub et al (phakic 2936 ± 262 cells/mm 2 , pseudophakic 2645 ± 200 cells/mm 2 ), but the donor population differs in terms of the lower proportion of pseudophakic eyes and the higher proportion of female donors compared with our study. Compared with other studies showing a negative influence of pseudophakia on corneal ECD [ 13 , 30 ], the negative influence determined in our study seems rather strong (378 cells/mm 2 less in pseudophakic eyes), although a direct comparison with other studies is not possible because of different study designs.…”

Alcohol Abuse Is Associated With Alterations in Corneal Endothelial Cell Morphology

“…The variability in the shape and size of cells is of particular importance because it is associated with cell stress and has been associated with a higher likelihood of corneal decompensation after intraocular surgery. 9,10 The estimated effect of alcohol abuse on ECD was modest at 60.9 cells/mm 2 , a small percentage of the median ECD in this study. This suggests that the findings, although statistically significant, may not reach the threshold for clinical significance for most donors.…”

“…The variability in the shape and size of cells is of particular importance because it is associated with cell stress and has been associated with a higher likelihood of corneal decompensation after intraocular surgery. 9,10…”

An Update on Corneal Biomechanics and Architecture in Diabetes

“…Chocron et al [148] and Liaboe et al [145] reported lower levels of ECD in diabetes patients when compared to controls. Chen et al [147] described this endothelial loss only in patients between 21 and 60 years; subjects above this age did not have statistically significant differences when compared to healthy controls. Moreover, Kwon et al [143] report that age, previous cataract surgery, and diabetes were found to be the most important risk factors for deficient donor quality with respect to ECD.…”