https://orcid.org/0000-0001-6090-6777
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Abstract
Purpose
To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery.
Patients and Methods
Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors’ previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors’ previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting.
Results
Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037).
Conclusion
Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation.
Meeting Presentation
ARVO 2023 New Orleans, La, USA (poster presentation).
Ethics Statement
The study was conducted in adherence to the tenets of the Declaration of Helsinki and was approved by the local Institutional Review Board (Ethics Commission of Cologne University’s Faculty of Medicine, Cologne, Germany; No. 14-373). All patients gave their informed consent.
Acknowledgments
We would like to thank Dr. Frank-Peter Nitschke – Medical Director of the Society for Transplantation Medicine Mecklenburg-Vorpommern gGmbH, Medical Director of the Multi Tissue Bank Mecklenburg-Western Pomerania (Gewebebank Mecklenburg-Vorpommern gGmbH (GBM-V)) and Dr. Andreas Knipper – CEO of the Multi Tissue Bank Mecklenburg-Western Pomerania (Gewebebank Mecklenburg-Vorpommern gGmbH (GBM-V)) for providing the donor data and for the overall support on performing this study. Furthermore, we would like to thank Dr. Petra Schiller and Prof. Martin Hellmich – Institute for Medical Statistics and Computational Biology (IMSB), University of Cologne for the support regarding the statistical analysis.
Disclosure
Professor Björn Bachmann reports personal fees from Heidelberg Engineering, outside the submitted work; In addition, Professor Björn Bachmann has a patent DMEK shooter system issued (EP3474776 B1, US 10,874,504, PCT/EP2020/055687, PCT/EP2020/072701). The authors report no other conflicts of interest in this work.