Descemet membrane adhesion strength is greater in diabetics with advanced disease compared to healthy donor corneas

作者：Schwarz Chaid; Aldrich Benjamin T; Burckart Kimberlee A; Schmidt Gregory A; Zimmerman M Bridget; Reed Cynthia R; Greiner Mark A^*; Sander Edward A^*

来源：Experimental Eye Research, 2016, 153: 152-158.

DOI：10.1016/j.exer.2016.10.015

• Descemet membrane endothelial keratoplasty
• Diabetes mellitus
• Cornea transplantation

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 TE, SE, TD, and T-MAX values for ND corneas were 0.78 +/- 0.07 mN/mm, 0.37 +/- 0.05 mNimm/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), TD (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.

• 出版日期2016-12