DMEK outcomes using nondiabetic grafts for recipients with diabetes mellitus

Ben J Janson; Daniel C Terveen; Matthew J Benage; M Bridget Zimmerman; David C Mixon; Benjamin T Aldrich; Jessica M Skeie; Gregory A Schmidt; Cynthia R Reed; Kenneth M Goins; Mark A Greiner

doi:10.1016/j.ajoc.2019.100512

DMEK outcomes using nondiabetic grafts for recipients with diabetes mellitus

Am J Ophthalmol Case Rep. 2019 Jul 9:15:100512. doi: 10.1016/j.ajoc.2019.100512. eCollection 2019 Sep.

Authors

Ben J Janson¹, Daniel C Terveen¹, Matthew J Benage¹, M Bridget Zimmerman², David C Mixon³, Benjamin T Aldrich^{1

3

4}, Jessica M Skeie^{1

3

4}, Gregory A Schmidt^{3

4}, Cynthia R Reed^{3

4}, Kenneth M Goins^{1

3

4}, Mark A Greiner^{1

3

4}

Affiliations

¹ Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
² Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
³ Iowa Lions Eye Bank, Coralville, IA, USA.
⁴ Cornea Research Center, University of Iowa, Iowa City, IA, USA.

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.

Keywords: Corneal endothelium; Corneal transplantation; DMEK; Descemet membrane; Diabetes mellitus; Endothelial keratoplasty.