Descemet membrane adhesion strength is greater in diabetics with advanced disease compared to healthy donor corneas. (December 2016)

• Record Type: Journal Article
• Authors: Schwarz, Chaid; Aldrich, Benjamin T.; Burckart, Kimberlee A.; Schmidt, Gregory A.; Zimmerman, M. Bridget; Reed, Cynthia R.; Greiner, Mark A.; Sander, Edward A.
• Is Part Of: Experimental eye research. Volume 153(2016:Dec.)
• Page Start: 152
• Page End: 158
• Publication Date: 2016-12
• Subjects: Descemet membrane endothelial keratoplasty -- Diabetes mellitus -- Cornea transplantation; Ophthalmology -- Periodicals; Eye -- Periodicals; Œil -- Périodiques; Ophthalmology; Periodicals; Electronic journals; 612.8405
• DOI: 10.1016/j.exer.2016.10.015
• Languages: English
• ISSNs: 0014-4835

Abstract

Abstract: Descemet membrane endothelial keratoplasty (DMEK) is an increasingly popular surgical procedure for treating ocular diseases that require a corneal transplant. Previous studies have found that tissue tearing during surgical preparation is more likely elevated in eyes from donors with a history of diabetes mellitus. To quantify these potential differences, we established an experimental technique for quantifying the force required to separate the endothelium-Descemet membrane complex (EDM) from stroma in human donor corneal tissue, and we assessed differences in adhesion strength between diabetic and non-diabetic donor corneas. Transplant suitable corneas were obtained from 23 donors 50–75 years old with an average preservation to assay time of 11.5 days. Corneas were classified from a medical records review as non-diabetic (ND, n = 9), diabetic without evidence of advanced disease (NAD, n = 8), or diabetic with evidence of advanced disease (AD, n = 10). Corneas were sectioned into 3 mm wide strips and the EDM peeled from the stroma. Using the force-extension data obtained from mechanical peel testing, EDM elastic peel tension ( T E ), elastic stiffness ( S E ), average delamination tension ( T D ), and maximum tension ( T MAX ) were calculated. Mean T E, S E, T D, and T MAX values for ND corneas were 0.78 ± 0.07 mN/mm, 0.37 ± 0.05 mN/mm/mm, 0.78 ± 0.08 mN/mm, and 0.94 ± 0.17 mN/mm, respectively. NAD values did not differ significantly. However, AD values for T E (1.01 ± 0.18 mN/mm), T D (1.09 ± 0.21 mN/mm), and T MAX (1.37 ± 0.24 mN/mm) were greater than ND and NAD corneas (P < 0.05). S E did not differ significantly between groups. These findings provide proof of the concept that chronic hyperglycemia from diabetes mellitus results in a phenotypically more adhesive interface between Descemet membrane and the posterior stroma in donor corneal tissue. Results of this study provide a foundation for further investigations into the impact of diabetes on the posterior cornea, eye banking, and keratoplasty. Graphical abstract: Highlights: A method to quantify the adhesion strength of Descemet membrane to the underlying stroma is proposed. Adhesion metrics are compared between non-diabetics and diabetics. Increased adhesion in chronic hyperglycemia due to diabetic mellitus is indicative of diabetic donor DMEK preparation failures.