title: Diabetes mellitus increases risk of unsuccessful graft preparation in Descemet membrane endothelial keratoplasty: a multicenter study.
abstract: OBJECTIVE
  The aim of this study was to evaluate preparation outcomes of tissue prepared for Descemet membrane endothelial keratoplasty (DMEK) from diabetic and nondiabetic donors.
  
  
  METHODS
  In this nonrandomized, consecutive case series, DMEK grafts were prepared from diabetic and nondiabetic donors by experienced technicians in 2 eye banks using slightly different, modified submerged manual preparation techniques to achieve "prestripped" graft tissue. Graft preparation results were analyzed retrospectively. The main outcome measure was the rate of unsuccessful (failed) DMEK graft preparations, defined as tears through the graft area that prevent tissue use.
  
  
  RESULTS
  A total of 359 corneas prepared from 290 donors (114 diabetic and 245 nondiabetic) were included in the statistical analysis of graft preparation failure. There were no significant differences between diabetic and nondiabetic donor tissue characteristics with respect to donor age, death to preservation time, death to preparation time, endothelial cell density, percent hexagonality, or coefficient of variation. DMEK tissue preparation was unsuccessful in 19 (5.3%) cases. There was a significant difference in the site-adjusted rate of DMEK preparation failure between diabetic [15.3%; 95% confidence interval (CI), 9.0-25.0] and nondiabetic donors (1.9%; 95% CI, 0.8-4.8), and the corresponding site-adjusted odds ratio of DMEK graft preparation failure in diabetic donor tissue versus nondiabetic donor tissue was 9.20 (95% CI, 2.89-29.32; P = 0.001).
  
  
  CONCLUSIONS
  Diabetes may be a risk factor for unsuccessful preparation of donor tissue for DMEK. We recommend caution in the use of diabetic tissue for DMEK graft preparation. Further study is needed to identify what subset of diabetic donors is at risk for unsuccessful DMEK graft preparation.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA; †Iowa Lions Eye Bank, Coralville, IA; ‡Lions VisionGift, Portland, OR; and §Devers Eye Institute, Portland, OR.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Rixen
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Schmidt
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Stoeger
authors.forename: Michael D
authors.initials: MD
authors.lastname: Straiko
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kitzmann
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
mesh_terms: D000368:Aged; D003886:Descemet Membrane / Q000473:pathology*; D057111:Descemet Stripping Endothelial Keratoplasty; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology*; D005125:Eye Banks; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013048:Specimen Handling; D014019:Tissue Donors