Influence of Donor Factors on Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Preparation Outcome

Silvia Schrittenlocher,1 Jithmi Weliwitage,2 Mario Matthaei,1 Björn Bachmann,1 Claus Cursiefen1,3 1Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany; 2University of Cologne, Institute for Medical Statistics and Computational Biology (IMSB), Cologne, NRW, Germany; 3University of Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, NRW, GermanyCorrespondence: Silvia Schrittenlocher, Kerpener Str. 62, Cologne, 50937, Germany, Tel +49 221– 4313, Fax +49 221– 3186, Email Silvia.Schrittenlocher@uk-koeln.dePurpose: 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.Keywords: DMEK, lamellar keratoplasty, donor, graft preparation, risk factors, cornea bank