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Implementation of a Diabetes Rating Scale Can Reduce DMEK Graft Preparation Failure Among Less Experienced Technicians
Andrew T. Duong, BA, Khoa D. Tran, PhD, Christopher S. Sales, MD, MPH, Doowon Huh, PhD1
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.