Margo Jordan A, Munir Wuqaas M, Brown Clayton H, Hoover Caroline K
Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.
JAMA Ophthalmol. 2017 Feb 1;135(2):124-130. doi: 10.1001/jamaophthalmol.2016.5095.
The rate of types 1 and 2 diabetes in the United States is increasing. The effect of diabetes on corneal donor tissue is unknown.
To determine the association between endothelial cell density and suitability for transplantation in cornea donors with type 1 or 2 diabetes and determine the effect of diabetes on technician-induced endothelial damage during cornea donor tissue processing.
DESIGN, SETTING, AND PARTICIPANTS: Donor information was obtained from the SightLife Eye Bank for donors from June 1, 2012, to June 30, 2015. The presence of diabetes was determined based on donor medical history. Severe diabetes was classified based on the presence of comorbidities of diabetes. The donor data set contained information on 34 497 donated eyes during the 3-year period, including donor demographics, time from death to refrigeration and preservation of the cornea, endothelial cell count, lens status, medical and surgical history, and suitability for transplantation.
Endothelial cell density, suitability for transplantation based on tissue analysis, and technician-induced endothelial damage.
Among 14 532 donors (mean [SD] age, 58.6 [13.4] years; 8516 men and 6016 women), the mean (SD) endothelial cell count was 2732 (437) cells/mm2. Type 1 or 2 diabetes was listed in the medical history for 8552 of 27 948 donor eyes (30.6%); 5242 eyes (18.8%) were from patients with severe diabetes. After adjusting for age, race/ethnicity, sex, lens status, time from death to refrigeration, and time from death to preservation, the presence of diabetes (adjusted odds ratio, 0.79; 95% CI, 0.51-1.22; P = .28) and severe diabetes (adjusted odds ratio, 95% CI, 0.86; 95% CI, 0.54-1.39; P = .54) were not associated with poor transplant suitability based on results of tissue examination. Donors with diabetes (mean [SD] cell count difference, 9.0 [6.7] cells/mm2; 95% CI, -4.1 to 22.2; P = .18) and severe diabetes (mean [SD] cell count difference, 7.7 [8.1] cells/mm2; 95% CI, -8.1 to 23.6; P = .34) did not exhibit lower cell counts. Technician-induced endothelial damage occurred in 59 corneas (0.2%) but was not associated with the presence of diabetes (adjusted odds ratio, 1.23; 95% CI, 0.66-2.32; P = .52).
These data suggest that cornea donors have a high frequency of diabetes. However, this analysis was not able to show that the presence of diabetes was associated with technician-induced endothelial damage, reduced transplant suitability, or reductions in endothelial cell counts. Eye banks may need to collect medical history in a more robust manner. Additional studies may be valuable to determine the effect on long-term transplant outcomes of diabetes in cornea donors.
美国1型和2型糖尿病的发病率正在上升。糖尿病对角膜供体组织的影响尚不清楚。
确定1型或2型糖尿病角膜供体的内皮细胞密度与移植适宜性之间的关联，并确定糖尿病对角膜供体组织处理过程中技术人员导致的内皮损伤的影响。
设计、地点和参与者：从SightLife眼库获取2012年6月1日至2015年6月30日期间供体的信息。根据供体病史确定是否存在糖尿病。根据糖尿病合并症情况对严重糖尿病进行分类。该供体数据集包含3年期间34497只捐献眼睛的信息，包括供体人口统计学信息、从死亡到角膜冷藏和保存的时间、内皮细胞计数、晶状体状态、医疗和手术史以及移植适宜性。
内皮细胞密度、基于组织分析的移植适宜性以及技术人员导致的内皮损伤。
在14532名供体（平均[标准差]年龄，58.6[13.4]岁；8516名男性和6016名女性）中，平均（标准差）内皮细胞计数为2732（437）个/mm²。27948只供体眼中有8552只（30.6%）的病史中列出了1型或2型糖尿病；5242只眼（18.8%）来自严重糖尿病患者。在调整年龄、种族/民族、性别、晶状体状态、从死亡到冷藏的时间以及从死亡到保存的时间后，糖尿病的存在（调整后的优势比，0.79；95%置信区间，0.51 - 1.22；P = 0.28）和严重糖尿病（调整后的优势比，95%置信区间，0.86；95%置信区间，0.54 - 1.39；P = 0.54）与基于组织检查结果的移植适宜性差无关。糖尿病供体（平均[标准差]细胞计数差异，9.0[6.7]个/mm²；95%置信区间，-4.1至22.2；P = 0.18）和严重糖尿病供体（平均[标准差]细胞计数差异，7.7[8.1]个/mm²；95%置信区间，-8.1至23.6；P = 0.34）的细胞计数并未降低。技术人员导致的内皮损伤发生在59只角膜中（0.2%），但与糖尿病的存在无关（调整后的优势比，1.23；95%置信区间，0.66 - 2.32；P = 0.52）。
这些数据表明角膜供体中糖尿病的发生率很高。然而，该分析未能表明糖尿病的存在与技术人员导致的内皮损伤、移植适宜性降低或内皮细胞计数减少有关。眼库可能需要更全面地收集病史。进一步的研究对于确定糖尿病对角膜供体长期移植结局的影响可能是有价值的。
