The Cornea Preservation Time Study (CPTS) is the largest, prospective, randomized, double-masked clinical trial of modern corneal transplantation to date. It involved more than 1300 Descemet stripping endothelial keratoplasty (DSEK) procedures performed by 70 experienced surgeons. By allowing a variety of DSEK techniques and postoperative care regimens, CPTS functioned as a real-world study.
One of the previously reported primary outcomes from this study was that preservation time up to 11 days had little effect on graft success up to 3 years.[1] A recently published analysis[2] of donor, recipient, and operative factors from CPTS has now identified some other interesting outcomes from this important study.
After controlling for preservation time, researchers found that tissue from donors with diabetes was associated with twice the risk for primary or early graft failure, a finding not seen in any prior large study on DSEK. Regardless, it must be noted that successful outcomes were obtained from 90% of tissue from donors with diabetes.
The CPTS did not collect data on the specifics of the diabetes, such as duration of diabetes, insulindependence, and severity of diabetes, including ocular and systemic complications. My sense is that not all diabetic donor tissue is equal. Tissue from a donor who has had insulin-dependent diabetes for 40 years may well act differently than tissue from a donor with recently diagnosed diet-controlled diabetes.
