Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Saving Sight Eye Bank, Kansas City, MO.
Cornea. 2019 Oct;38(10):1203-1208. doi: 10.1097/ICO.0000000000002047.
To determine whether donor diabetes mellitus (DM) severity is associated with differences in endothelial cell density (ECD) and surgically unsuitable tissue.
Raw data were obtained from Saving Sight Eye Bank (Kansas City, MO) including 10,454 donated eyes from 5346 eligible donors from July 2014 through May 2017. Donors were grouped into 5 categories by their insulin use and the presence of microvascular end-organ complications. The categories were non-DM (NDM), noninsulin-dependent DM without complications (NIDDMnc), noninsulin-dependent DM with complication (NIDDMc), insulin-dependent DM without complications, and insulin-dependent DM with complication. Outcome variables included ECD and tissue transplant suitability. Mixed effects models were used to adjust for the random effect of repeated measures and fixed effects of donor age, race, lens status, and death to refrigeration and death to preservation times. Interaction effects of DM severity group and donor age and DM severity group and lens status were included in the models.
One thousand six hundred eighty-four (32.1%) donors had a diagnosis of DM. Six hundred fifty-eight donors were in the NIDDMnc group, 225 in the NIDDMc group, 404 in the insulin-dependent DM without complication group, and 397 in the insulin-dependent DM with complication group. Compared with non-DM, donors with DM were older (P < 0.001) and more likely to be pseudophakic (P < 0.001). DM severity groups did not affect adjusted ECD at mean donor age. There was no statistically significant ECD interaction between DM severity group and lens status. There was a statistically significant ECD crossover interaction with NIDDMnc and donor age (P < 0.001). In phakic eyes, NIDDMc was associated with a statistically significantly lower odds of transplant suitability (odds ratio 0.62, P = 0.006).
DM severity does not affect lowering adjusted ECD at mean donor age. DM severity and pseudophakia were not associated with lower adjusted ECD. NIDDMnc was associated with an attenuation of the age-dependent decrease in ECD. NIDDMc was associated with decreased transplant suitability in phakic eyes. Future studies should include age, lens status, and interaction effects in their models of ECD and transplant suitability.
确定供体糖尿病（DM）严重程度是否与内皮细胞密度（ECD）和手术不适用组织的差异有关。
从 2014 年 7 月至 2017 年 5 月，从堪萨斯城 Saving Sight 眼库（堪萨斯城，MO）获得原始数据，其中包括 5346 名合格供体的 10454 只捐献眼。供体根据胰岛素使用情况和微血管终末器官并发症的存在分为 5 组。这些类别是非糖尿病（NDM）、无并发症的非胰岛素依赖型糖尿病（NIDDMnc）、有并发症的非胰岛素依赖型糖尿病（NIDDMc）、无并发症的胰岛素依赖型糖尿病和有并发症的胰岛素依赖型糖尿病。观察指标包括 ECD 和组织移植的适宜性。采用混合效应模型，对供体年龄、种族、晶状体状态、冷藏至死亡时间和保存至死亡时间的重复测量的随机效应以及供体年龄、DM 严重程度组和晶状体状态的固定效应进行调整。模型中包括 DM 严重程度组与供体年龄和 DM 严重程度组与晶状体状态的交互作用。
1684 名（32.1%）供体诊断为 DM。658 名供体属于 NIDDMnc 组，225 名属于 NIDDMc 组，404 名属于无并发症的胰岛素依赖型 DM 组，397 名属于有并发症的胰岛素依赖型 DM 组。与非 DM 相比，DM 供体年龄较大（P<0.001），更有可能是无晶状体眼（P<0.001）。DM 严重程度组在平均供体年龄时对调整后的 ECD 没有影响。DM 严重程度组与晶状体状态之间的 ECD 无统计学显著交互作用。NIDDMnc 与供体年龄（P<0.001）之间存在统计学显著的 ECD 交叉相互作用。在有晶状体眼中，NIDDMc 与移植适宜性的几率显著降低相关（比值比 0.62，P=0.006）。
DM 严重程度不会影响平均供体年龄时调整后的 ECD 降低。DM 严重程度和无晶状体眼与 ECD 降低无关。NIDDMnc 与年龄相关的 ECD 降低程度减弱有关。NIDDMc 与有晶状体眼移植适宜性降低有关。未来的研究应在 ECD 和移植适宜性的模型中包括年龄、晶状体状态和交互作用。
