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Original Investigation
February 2017

Association Between Endothelial Cell Density and Transplant Suitability of Corneal Tissue With Type 1 and Type 2 Diabetes

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore
  • 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
  • 3SightLife Inc, Seattle, Washington
JAMA Ophthalmol. 2017;135(2):124-130. doi:10.1001/jamaophthalmol.2016.5095
Key Points

Question  What is the effect of type 1 or 2 diabetes on endothelial cell density, corneal transplant suitability, and technician-induced cell damage on eye bank donor characteristics?

Findings  This database study found that 8552 of 27 948 eyes (30.6%) during the 3-year study period were from donors with diabetes. No correlation was identified between the presence of diabetes or severe diabetes and poor transplant suitability, reduced endothelial cell counts, or technician-induced tissue damage.

Meaning  Regardless of disease severity, the presence of diabetes in corneal donors was not shown to reduce endothelial cell density or limit tissue suitability for transplantation.


Importance  The rate of types 1 and 2 diabetes in the United States is increasing. The effect of diabetes on corneal donor tissue is unknown.

Objectives  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.

Main Outcomes and Measures  Endothelial cell density, suitability for transplantation based on tissue analysis, and technician-induced endothelial damage.

Results  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).

Conclusions and Relevance  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.