title: Assessing the Impact of Diabetes Mellitus on Donor Corneal Endothelial Cell Density.
abstract: OBJECTIVE
  To quantify changes in endothelial cell density (ECD) of donor corneal tissue in relation to the presence or absence of a medical history of diabetes mellitus diagnosis, treatment, and complications.
  
  
  METHODS
  A retrospective review was performed for all corneas collected at Iowa Lions Eye Bank between January 2012 and December 2015. For purposes of analysis, donor corneas were divided into 4 groups: nondiabetic, non-insulin-dependent diabetic, insulin-dependent diabetic without medical complications due to diabetes, and insulin-dependent diabetic with medical complications due to diabetes. ECD values (obtained through specular microscopy) and transplant suitability for endothelial transplantation (determined by the standard protocol of the eye bank) were compared among groups using linear mixed model analysis.
  
  
  RESULTS
  In total, 4185 corneas from 2112 donors were included for analysis. Insulin-dependent diabetic samples with medical complications due to diabetes (N = 231 from 119 donors) showed lower ECD values compared with nondiabetic samples (-102 cells/mm, P = 0.049) and non-insulin-dependent diabetic samples (-117 cells/mm, P = 0.031). ECD values did not differ significantly among the remaining groups. The likelihood of suitability for endothelial transplantation did not differ among all 4 groups.
  
  
  CONCLUSIONS
  Corneas from donors with insulin-dependent diabetes mellitus and medical complications resulting from the disease have lower mean ECD values compared with other donors. However, our analysis suggests that these corneas are equally likely to be included in the donor pool for corneal transplantation. Additional studies are needed to determine the mechanism(s) contributing to cell loss in donors with advanced diabetes and to assess associated endothelial cell functional impairment.
authors.affiliation: *Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA; †Cornea Research Center, Carver College of Medicine, University of Iowa, Iowa City, IA; ‡Iowa Lions Eye Bank, Coralville, IA; and §Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: Chase A
authors.initials: CA
authors.lastname: Liaboe
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Aldrich
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Carter
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Skeie
authors.forename: Kimberlee A
authors.initials: KA
authors.lastname: Burckart
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Schmidt
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Reed
authors.forename: M Bridget
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greiner
mesh_terms: D000368:Aged; D002452:Cell Count; D003315:Cornea / Q000473:pathology*; D048909:Diabetes Complications / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D042783:Endothelial Cells / Q000166:cytology*; D004728:Endothelium, Corneal / Q000166:cytology*; D005125:Eye Banks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors