Abstract
Purpose :
Little is known about the influence of donor factors on Descemet membrane endothelial keratoplasty (DMEK) preparation behavior. We performed a retrospective observational clinical study to determine which donor characteristics influence the preparation behavior of the Descemet membrane (DM)/endothelial lamella.
Methods :
By combining a large prospective donor database from the Mecklenburg-Vorpommern donor bank and the prospective Cologne DMEK outcome database, we included 846 eyes that received a DMEK. Preparation difficulty criteria of the DM/endothelial lamella (like DM splitting, stripping, rolling behavior, fragility, central/peripheral adherences and staining of the tissue) were associated with donor characteristics (age, endothelial cell density, preexisting diseases, preexisting eye surgeries, nicotine consumption). Three preparation categories (easy, difficult and very difficult) were correlated to four preparation criteria (DM-splitting, fragility, central and peripheral adherences). Wilcoxon signed exact test and Pearson’s Chi-square test were used for statistical analysis.
Results :
Significant associations were found between DM splitting with stripping (p<0.001), lamella rolling behavior (p<0.001), previous cataract surgery (p<0.001), previous eye surgery (p=0.021), and preexisting diabetes (p=0.019). Also, increased difficulty of stripping and stronger rolling behavior of the lamella was found to be significantly associated and correlated with previous donor cataract surgery (Cor=0.171, p<0.001 and Cor=240, p<0.001 respectively). Preexisting diabetes mellitus type 2 was significantly associated with central adherences during preparation (p=0.001). When considering the specific difficulty of preparation and categorization into the three groups, diabetes type 2 and heart failure were found to be significantly associated with the preparation difficulty (p=0.003 and p=0.036 respectively). Furthermore, a difficult lamella preparation was not found to be associated with the donors’ nicotine consumption.
Conclusions :
In this preliminary study, we could confirm that diabetes, especially type 2, heart failure and previous cataract surgery, are associated with a more difficult preparation of the Descemet membrane-endothelial lamella. Further studies need to examine the impact on clinical outcome.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.