Jonathan H. Lass, Jonathan H. Lass, Beth Ann Benetz, David D. Verdier, Loretta B. Szczotka-Flynn, Colleen E. Bauza, Zachariah W. Reed, Mark A. Greiner, Shahzad I. Mian, Sanjay V. Patel, Sudeep Pramanik, Francis W. Price, Mark C. Soper, Mark A. Terry, Michael S. Titus, Craig Kollman, Roy W. Beck, Marianne O. Price, Diabetes Endothelial Keratoplasty Study Group, Anjulie Gang, Taylor Hall, Katelyn Lucas, Ashlyn Lynn, Shawna Cole, Derek Phelps, Keith H. Baratz, Elainey Hardtke, Emily J. Treichel, Christopher Hood, Nambi Nallasamy, Angela Verkade, Kristin Jones, Jeremy N. Shapiro, Christopher S. Sáles, Lisa Leavy, Chris Sinkey, Lawrence R. Tenkman, DJ Gordon, Christopher Ketcherside, Jenni Fox, Kristy Coonfield, Jesse M. Vislisel, Yogi Sharma, Angela M. Young, Evan Schoenberg, Sharra Kelly, James Huffman, Melinda Sears, Merisa Stone, Paul Phillips, Charlene Maloney, Divya Srikumaran, Yassine J. Daoud, Allen O. Eghrari, Albert S. Jun, Muhammad Ali, Christina Maria, Michelle Boyce, Yong Kam, Vicki Crosser, Jessica Chen, Michael D. Straiko, Alex Bauer, Christopher Croasdale, Gayle Waldheim Brown, Peter B. Veldman, Que Evans, Parag A. Majmudar, Rachel Epstein, Neal Vaidya, Marie Rosselson, Jim Nykaza, Ula V. Jurkunas, Nandini Venkateswaran, Michael K. Cheung, Brandon D. Ayres, Drew Monteleone Haught, Elizabeth Prasad, G Toti, Jim Wier, Ari Brandsdorfer, Denise Pape, Mark Hansen, David R. Hardten, Sherman Reeves, Allison Dreyer, Megan Mack, M. Bowes Hamill, Jessica Nguyen, Ellen Koo, Ryan Stanfield, Michael Greenwood, L Ernst, Brooke Messer, Nick Risbrudt, Seth Stofferahn, Alyson Saville, Ahmed F. Omar, Leslie Castaneda, Nidia Torres
Importance: The effect of cornea donor diabetes on endothelial cell density (ECD) and morphometry after Descemet membrane endothelial keratoplasty (DMEK) is not known. Objective: To determine whether endothelial cell loss (ECL) and morphometric changes 1 year after successful DMEK are related to cornea donor's diabetes status. Design, Setting, and Participants: This was a multicenter, double-masked, randomized clinical trial conducted from February 2022 to July 2024 at 28 US clinical sites (46 surgeons) and 13 eye banks. Included in the trial were the eyes of recipients (some of whom received tissue from donors without diabetes and others who received tissue from donors with diabetes) who underwent successful DMEK, primarily for Fuchs endothelial corneal dystrophy, and had at least 1 analyzable postoperative endothelial image. Intervention: DMEK performed with a cornea from a donor without or with diabetes, assigned using a minimization procedure to achieve an approximate 2:1 distribution. Main Outcomes and Measures: ECD, ECL, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX) at 1 year from eye bank and postoperative specular central endothelial images. Results: A total 1274 eyes of 982 recipients (mean [SD] age, 70 [8] years; 569 female [57.9%]; 816 [64.1%] with tissue from donors without diabetes and 458 [35.9%] with tissue from donors with diabetes) were included in the study. Preoperatively, mean (SD) central ECD in tissue from donors without diabetes and with diabetes were 2676 (290) cells/mm2 and 2671 (286) cells/mm2, respectively. At 1 year, mean (SD) ECL was 28.3% (16.1%) and 28.0% (17.0%), in the donor groups without and with diabetes, respectively (adjusted mean difference = -0.4%; 95% CI, -2.3% to 1.4%), resulting in a mean (SD) 1-year ECD of 1927 (498) cells/mm2 and 1920 (496) cells/mm2, respectively (adjusted mean difference = 10 cells/mm2; 95% CI, -36 to 56; P = .95). No difference in ECD at 1 year associated with diabetes severity was noted (P = .97). Mean (SD) CV did not differ at 1 year between the 2 groups of eyes (31.5% [4.1%] vs 31.4% [4.1%]; adjusted mean difference = -0.4%; 95% CI, -0.9% to 0.1%; P = .51), and mean (SD) HEX did not differ at 1 year between the 2 groups of eyes (57.7% [5.8%] vs 57.2% [5.8%]; adjusted mean difference = 0.1%, 95% CI, -0.8% to 0.9%; P = .33). Conclusions and Relevance: This randomized clinical trial found that ECL and morphometry 1 year after DMEK were not affected by cornea donor diabetes status. With comparable 1-year graft success with tissue from donors with and without diabetes demonstrated in this trial, these findings support the use of corneas from donors with diabetes for endothelial keratoplasty procedures. Trial Registration: ClinicalTrials.gov Identifier: NCT05134480.