June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Structural and biochemical alterations of the posterior cornea associated with diabetes mellitus
Author Affiliations & Notes
  • Theofilos Tourtas
    Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
  • Friedrich E Kruse
    Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
  • Benjamin Thomas Aldrich
    Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Coralville, Iowa, United States
  • Julia M Weller
    Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
  • Jessica M Skeie
    Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Coralville, Iowa, United States
  • Gregory A Schmidt
    Iowa Lions Eye Bank, Coralville, Iowa, United States
    Cornea Research Center, University of Iowa, Iowa City, Iowa, United States
  • Cynthia R Reed
    Iowa Lions Eye Bank, Coralville, Iowa, United States
    Cornea Research Center, University of Iowa, Iowa City, Iowa, United States
  • Mark A Greiner
    Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
    Iowa Lions Eye Bank, Coralville, Iowa, United States
  • Ursula Schlotzer-Schrehardt
    Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
  • Footnotes
    Commercial Relationships   Theofilos Tourtas, None; Friedrich Kruse, None; Benjamin Aldrich, None; Julia Weller, None; Jessica Skeie, None; Gregory Schmidt, None; Cynthia Reed, None; Mark Greiner, None; Ursula Schlotzer-Schrehardt, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5704. doi:
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      Theofilos Tourtas, Friedrich E Kruse, Benjamin Thomas Aldrich, Julia M Weller, Jessica M Skeie, Gregory A Schmidt, Cynthia R Reed, Mark A Greiner, Ursula Schlotzer-Schrehardt; Structural and biochemical alterations of the posterior cornea associated with diabetes mellitus. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5704.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Previous studies have reported on diabetes mellitus as a risk factor for unsuccessful graft preparation in Descemet membrane endothelial keratoplasty (DMEK). Greater adhesion strength of Descemet membrane (DM) to corneal stroma has been postulated as a cause for this finding. The aim of this study was to perform a comparative analysis of potentially causative structural and biochemical alterations in the posterior cornea of diabetic and non-diabetic donors.

Methods : Corneoscleral tissue was obtained from 25 donors 49-75 years of age. Corneas were classified from a medical records review as non-diabetic (n=10) or diabetic (n=15). Transmission electron microscopy was used to analyze ultrastructural alterations in DM and posterior stroma. Light and electron microscopic immunohistochemistry was performed using a panel of antibodies against adhesive matrix glycoproteins and advanced glycation endproducts (AGEs). ImageJ was used to quantitate fluorescence intensity after correcting for negative control background.

Results : Transmission electron microscopy showed a moderate but statistically not significant increase in thickness of DM in diabetic samples (12.3±2.7µm) compared to non-diabetic controls (10.2±1.8µm). Diabetic corneas revealed a more prominent interfacial matrix at the DM-stroma boundary containing pronounced vacuolar inclusions as well as abnormal accumulations of banded, collagen type III-positive material in the posterior layer of DM. These ultrastructural alterations were not observed in control corneas. Quantitative analysis of immunofluorescence signals revealed increased amounts of AGEs in diabetic vs. non-diabetic corneas (p<0.001; t test). Staining reaction was most pronounced at the interface region and co-localized with ECM proteins such as fibronectin and vitronectin representing obvious targets of glycation reactions.

Conclusions : These findings support the concept that chronic hyperglycemia from diabetes mellitus results in an altered, more adhesive interface between DM and posterior stroma in donor corneas. The impact of diabetes on structural and biochemical interface matrix changes is considered relevant for eye banking and graft preparation during DMEK surgery.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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