title: Descemet membrane adhesion strength is greater in diabetics with advanced disease compared to healthy donor corneas.
abstract: Descemet membrane endothelial keratoplasty (DMEK) is an increasingly popular surgical procedure for treating ocular diseases that require a corneal transplant. Previous studies have found that tissue tearing during surgical preparation is more likely elevated in eyes from donors with a history of diabetes mellitus. To quantify these potential differences, we established an experimental technique for quantifying the force required to separate the endothelium-Descemet membrane complex (EDM) from stroma in human donor corneal tissue, and we assessed differences in adhesion strength between diabetic and non-diabetic donor corneas. Transplant suitable corneas were obtained from 23 donors 50-75 years old with an average preservation to assay time of 11.5 days. Corneas were classified from a medical records review as non-diabetic (ND, n = 9), diabetic without evidence of advanced disease (NAD, n = 8), or diabetic with evidence of advanced disease (AD, n = 10). Corneas were sectioned into 3 mm wide strips and the EDM peeled from the stroma. Using the force-extension data obtained from mechanical peel testing, EDM elastic peel tension (TE), elastic stiffness (SE), average delamination tension (TD), and maximum tension (TMAX) were calculated. Mean TE, SE, TD, and TMAXvalues for ND corneas were 0.78 ± 0.07 mN/mm, 0.37 ± 0.05 mN/mm/mm, 0.78 ± 0.08 mN/mm, and 0.94 ± 0.17 mN/mm, respectively. NAD values did not differ significantly. However, AD values for TE(1.01 ± 0.18 mN/mm), TD(1.09 ± 0.21 mN/mm), and TMAX(1.37 ± 0.24 mN/mm) were greater than ND and NAD corneas (P < 0.05). SEdid not differ significantly between groups. These findings provide proof of the concept that chronic hyperglycemia from diabetes mellitus results in a phenotypically more adhesive interface between Descemet membrane and the posterior stroma in donor corneal tissue. Results of this study provide a foundation for further investigations into the impact of diabetes on the posterior cornea, eye banking, and keratoplasty.
authors: Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA.
authors: Chaid
authors: C
authors: Schwarz
authors: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Iowa Lions Eye Bank, Coralville, IA, USA.
authors: Benjamin T
authors: BT
authors: Aldrich
authors: Iowa Lions Eye Bank, Coralville, IA, USA.
authors: Kimberlee A
authors: KA
authors: Burckart
authors: Iowa Lions Eye Bank, Coralville, IA, USA.
authors: Gregory A
authors: GA
authors: Schmidt
authors: College of Public Health, Department of Biostatistics, University of Iowa, Iowa City, IA, USA.
authors: M Bridget
authors: MB
authors: Zimmerman
authors: Iowa Lions Eye Bank, Coralville, IA, USA.
authors: Cynthia R
authors: CR
authors: Reed
authors: Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Iowa Lions Eye Bank, Coralville, IA, USA; Cornea Research Center, Stephen A. Wynn Institute for Vision Research, Iowa City, IA, USA. Electronic address: mark-greiner@uiowa.edu.
authors: Mark A
authors: MA
authors: Greiner
authors: Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA. Electronic address: edward-sander@uiowa.edu.
authors: Edward A
authors: EA
authors: Sander
mesh_terms: D000368:Aged; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D003886:Descemet Membrane / Q000502:physiology*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D003920:Diabetes Mellitus; D005125:Eye Banks; D006085:Graft Survival; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting
keywords: Cornea transplantation; Descemet membrane endothelial keratoplasty; Diabetes mellitus