Implementation of a Diabetes Rating Scale Can Reduce DMEK Graft Preparation Failure Among Less Experienced Technicians

Authors

Andrew T. Duong, BA, Khoa D. Tran, PhD, Christopher S. Sales, MD, MPH, Doowon Huh, PhD1

Abstract

Purpose: To compare rates of graft preparation failure (GPF) during Descemet membrane endothelial keratoplasty (DMEK) processing before and after implementing a previously published rating scale. Donor tissues rated 1-3 had mild diabetes and low risk of GPF; those rated 4-5 had severe diabetes and high risk of GPF.
Methods: Retrospective review of donor corneas for DMEK processing from 2012-2020 at a single eye bank with post hoc analysis.
Results: Of 3,376 donor corneas processed for DMEK following diabetes scale implementation, 24.6% had diabetes. Grafts rated 4-5 with rating known to the technician (i.e. after scale implementation) (n=314) had a GPF rate of 5.4%. Post-hoc analysis of tissues with the same rating but unknown to the technician (n=60) had a GPF rate of 25.0% (P<0.01). For grafts rated 1-3, the GPF rate was 4.6% vs. 3.3% before and after implementation of the scale, respectively (P=0.48). For experienced technicians (>150 tissues processed), no significant difference was seen in GPF rates for diabetic tissue following implementation of the diabetes rating scale (4.6% vs. 3.7%, p=0.70). For inexperienced technicians, however, the GPF rate fell significantly after the scale (15.0% vs. 6.3%, p=0.02).
Conclusions: Knowledge of diabetic status and severity prior to processing can help eye bank technicians, particularly those with limited experience, mitigate risk of GPF.