DMEK outcomes using nondiabetic grafts for recipients with diabetes mellitus

Abstract

Purpose To compare Descemet membrane endothelial keratoplasty (DMEK) outcomes using nondiabetic grafts in diabetic and nondiabetic recipients. Methods All eyes that underwent DMEK between February 2013 and October 2016 (follow-up ≥3 months, without prior keratoplasty) were included. Recipients were divided into diabetic (insulin dependent [IDDM] or noninsulin dependent [NIDDM]) and nondiabetic groups. Main outcome measures included postoperative visual acuity, rebubble procedure rates, and graft failure rates. Results Of 334 eyes (243 subjects) included for analysis, 63 eyes (18.8%) were from diabetic recipients. At each timepoint, best-corrected visual acuity trended lower for IDDM recipients compared to NIDDM and nondiabetic recipients. There were no statistically significant differences in rebubble rates of diabetic compared to nondiabetic recipients (20.6% vs. 12.9%, p = 0.17), or IDDM compared to nondiabetic recipients (27.3% vs. 12.9%, p = 0.08; hazard ratio 2.26). Overall, 13 grafts (3.9%) failed (mean follow-up, 565 days; range, 90–1293 days). Graft failures did not differ between diabetic and nondiabetic recipients (4.0% vs. 4.9%, p = 0.15) regardless of subgroup (p = 0.36). Conclusions DMEK provides excellent outcomes for patients with and without diabetes. DMEK outcomes were excellent with improvements in visual acuity and low rates of graft failure. Our findings were unable to determine differences between rebubble procedure rates but do emphasize the need for further research using stratified groups based on diabetes severity.

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“…More recently, the effects of T2DM on CECs have become better understood, especially with respect to endothelial keratoplasty and surgical outcomes. 88,89 Prior to transplant, graft tissues from donors with advanced diabetes have lower than average CEC densities, 90 and 3 years following DSAEK surgery diabetic donor graft tissues display more cell loss compared to nondiabetic control tissues, as well as increased graft failure rates. 91,92 Advanced diabetic donor tissues also have altered extracellular matrix properties impacting their biomechanical stiffness.…”

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“…Similarly, Price et al ( 32 ) reported that patients with diabetes experienced more endothelial cell loss after the graft than non-diabetic patients but with no visual consequences. Price also reported that diabetes status is correlated with an increased risk of rebubbling, as did Janson et al ( 33 ). The latter studied the relationship between DMEK outcomes and diabetes in 41 patients with diabetes not on insulin therapy, 22 patients with diabetes on insulin therapy, and 271 controls.…”