JAMA Network JAMA Ophthalmology : Diabetes in the Donor and Descemet Membrane Endothelial Keratoplasty Success at 1 Year
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Oct 17, 2025 In this engaging discussion, Dr. Jonathan Lass, a professor at Case Western Reserve University and leading researcher on the Diabetes Endothelial Keratoplasty Study, delves into the effects of donor diabetes on DMEK outcomes. He explains the rising popularity of DMEK, the key role of hemoglobin A1c in classifying donor diabetes, and the trial's impressive success rates—96% for non-diabetic and 97% for diabetic donors. Dr. Lass also shares insights on preparation failures and offers reassurances for surgeons regarding graft outcomes.
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Validated Postmortem A1c For Donor Classification
- The study validated post-mortem hemoglobin A1c as a reliable method to classify donor diabetes within 90 days of death.
- This ensured accurate grouping since many donors have undiagnosed diabetes, improving trial validity.
How The Trial Originated
- The trial idea grew from early observations of higher prep failures as DMEK gained popularity about 20 years ago.
- That motivated randomized study design to assess both prep and long-term transplant outcomes.
Large, Powered, Multicenter Trial Design
- The trial required 1,420 eyes to detect a 5% difference in one-year success, reflecting rigorous power planning.
- They enrolled a 2:1 split (no-diabetes:diabetes) to match donor population prevalence and consent realities.