Koo, Ellen H.
https://orcid.org/0000-0002-5016-2775
Mayo Clinic
for the Diabetes Endothelial Keratoplasty Study Group
Citations 2
Donor Diabetes and 1-Year Descemet Membrane Endothelial Keratoplasty Success Rate
Price, Francis W. , Szczotka‐Flynn, Loretta , Bauza, Colleen , Reed, Zachariah W., Arafah, Baha M. , Greiner, Mark A. , Johnson, Paula, Keeler, Devon B., Pramanik, Sudeep, Soper, Mark, Terry, Mark A., Titus, Michael S. , Verdier, David D. , Kollman, Craig, Lass, Jonathan H. , Lass, Jonathan H., Group, Diabetes Endothelial Keratoplasty Study, Gang, Anjulie, Hall, Taylor, Lynn, A. G., Cole, Shawna, Phelps, Derek, Baratz, Keith H. , Hardtke, Elainey, Treichel, Emily J., Hood, Christopher , Nallasamy, Nambi , Verkade, Angela , Jones, Kristin, Shapiro, Jeremy, Leavy, Lisa, Sinkey, Chris, Tenkman, Lawrence R., Gordon, DJ, Ketcherside, Christopher, Fox, Jenni, Coonfield, Kristy, Vislisel, Jesse M., Sharma, Yogi, Young, Angela M. , Schoenberg, Evan, Kelly, Sharra, Huffman, James L. , Sears, Melinda, Stone, Merisa, Phillips, Paul, Maloney, Charlene, Jun, Albert S. , Maria, Christina, Boyce, Michelle, Kam, Yong, Crosser, Vicki, Chen, Jessica , Straiko, Michael D., Bauer, Alex, Croasdale, Christopher, Brown, Gayle Waldheim, Veldman, Peter B., Evans, Que, Majmudar, Parag A., Epstein, Rachel , Vaidya, N. N., Nykaza, Jim, Venkateswaran, Nandini, Ayres, Brandon D. , Haught, Drew Monteleone, Prasad, Elizabeth, Toti, Gwen, Wier, Jim, Brandsdorfer, Ari, Pape, Denise, Hansen, Mark D., Hardten, David R., Reeves, Sherman W., Dreyer, Allison, Mack, Megan, Hamill, Mark, Nguyen, Jessica , Stanfield, Ryan, Greenwood, Michael , Ernst, Lindsay, Risbrudt, Nick, Saville, Alyson, Castaneda, Leslie, Torres, Nidia, Potts, Luke B. , Alexander, Jamie, Rinn, Jennifer, Bokosky, John, Cardenas, Ilina, Murphy, Doreen, Priebe, Kinsey, Sica, Chris, Buckman, Natalie, Ansin, Amy, Clover, Jameson , Pivoney, Charles, Vizzerra, Anthony, Elbanhawy, Lindsey, Mullins, Monica, Statz, Brianne, Fout, Elizabeth, Drury, Donna, Tavolazzi, Trisha, Lass, Jonathan, Lass, Jonathan, Richards, Leslie, Raghupathy, Sangeetha, Spruill, Rashad, Bauza, Colleen, Beck, Roy, Garrett, Kaitlyn, Reed, Zachariah, Benetz, Beth Ann , Lê, Jimmy T. , Redford, Maryann , Arafah, Baha, Greiner, Mark, Keeler, Devon, Monnier, Vincent M. , Titus, Michael, Verdier, David, Velhuisen, Paul Van, Hawkins, Barbara S., Macsai, Marian S., Patel, Sanjay, Mian, Shahzad I. , Pramanik, Sudeep , Price, Francis, Terry, Mark, Sell, David, Gabrielson, Deanna, Barton, Glenn, Bear, Andrew, Das, Pravamaya, Dawson, Lauren, Dingess, Ryan, Madere, Mark, Wadleigh, Garth, Price, Marianne O. , Mian, Shahzad I. , Patel, Sanjay V. , Pramanik, Sudeep, Titus, Michael S., Beck, Roy W. , Lass, Jonathan H., Group, Diabetes Endothelial Keratoplasty Study, Lynn, Ashlyn, Cole, Shawna, Phelps, Derek, Hardtke, Elainey, Hood, Christopher, Shapiro, Jeremy, Sáles, Christopher S. , Leavy, Lisa, Gordon, DJ, Fox, Jenni, Coonfield, Kristy, Young, Angela, Schoenberg, Evan, Kelly, Sharra, Huffman, James, Sears, Melinda, Stone, Merisa, Srikumaran, Divya S. , Daoud, Yassine J. , Eghrari, Allen Omid , Ali, Muhammad , Crosser, Vicki, Croasdale, Christopher, Brown, Gayle Waldheim, Evans, Que, Epstein, Rachel H. , Nykaza, Jim, Jurkunas, Ula V. , Cheung, Michael, Wier, Jim, Brandsdorfer, Ari, Pape, Denise, Mack, Megan, Hamill, M. Bowes, Nguyen, Jessica, Koo, Ellen H. , Stanfield, Ryan, Risbrudt, Nick, Saville, Alyson, Omar, Ahmed F. , Castaneda, Leslie, Torres, Nidia, Bokosky, John, Cardenas, Ilina, Murphy, Doreen, Priebe, Kinsey, Schmidt, Gregory A. , Elbanhawy, Lindsey, Statz, Brianne, Tavolazzi, Trisha, Lass, Jonathan, Lass, Jonathan, Richards, Leslie, Spruill, Rashad, Bauza, Colleen, Beck, Roy, McCarthy, Chris, Reed, Zachariah, Arafah, Baha, Greiner, Mark, Titus, Michael, Verdier, David, Velhuisen, Paul Van, Aleppo, Grazia , Bateman-House, Alison , Tu, Elmer Yuchen , Patel, Sanjay, Price, Francis, Terry, Mark, Sell, David, Barton, Glenn, Das, Pravamaya, Dingess, Ryan, Madere, Mark, Sengupta, Partha Pratim , Wadleigh, Garth
JAMA Ophthalmology | October 17, 2025 | Volume: 143 | Issue: 12 | Pages: 1043
10.1001/jamaophthalmol.2025.4253
Importance If the success of Descemet membrane endothelial keratoplasty (DMEK) is not affected by whether the donor has diabetes, then the donor pool should expand. Objective To determine whether the 1-year DMEK success rate is affected by the presence of diabetes in the donor. Design, Setting, and Participants This was a multicenter, double-masked, randomized clinical trial conducted from February 2022 to July 2025 at 28 clinical sites (46 surgeons), with donor corneas provided by 13 eye banks in the US. Included in the study were individuals undergoing low to moderate risk DMEK (95% for Fuchs endothelial corneal dystrophy). Study data were analyzed from April to September 2025. Intervention DMEK performed with a cornea from a donor without or with diabetes, assigned using a minimization procedure (comparable with randomization) to achieve an approximate 2:1 distribution, respectively. Main Outcomes and Measures Graft success at 1 year Results A total of 1097 individuals (1421 study eyes; median [IQR] age, 71 [66-76] years; 631 female [57.5%]) were included in the study. The 1-year cumulative probability of graft success was 96.3% (95% CI, 95.0%-97.5%) among 912 study eyes (64.2%) receiving tissue from donors without diabetes and 97.1% (95% CI, 95.5%-98.4%) among 509 study eyes (35.8%) receiving tissue from donors with diabetes (difference between groups = 0.7 percentage points; 95% CI, −1.2 to 2.6; P = .63). The 1-year cumulative probability of graft success was 96.5% (95% CI, 93.6%-98.9%) in the mild donor diabetes severity subgroup (n = 173) and 97.3% (95% CI, 95.4%-98.8%) in the moderate to severe donor diabetes severity subgroup (n = 336), using a diabetes severity rating scale based on medical history. The rates of primary donor failure, early failure related to surgical complications, and subsequent failure were as follows: 2.5% (23 of 912), 0.7% (6 of 912), and 0.3% (3 of 912), respectively, in recipients of tissue from a donor without diabetes, and 2.6% (13 of 509), 0.4% (2 of 509), and 0%, respectively, among recipients of tissue from a donor with diabetes. There were no failures due to graft rejection. Conclusions and Relevance The 1-year success rate in eyes undergoing DMEK with successfully prepared tissue was very high regardless of donor diabetes status. These results, supported by the separately reported finding that endothelial cell loss and cornea morphometry after 1 year were not affected by donor diabetes status, provide strong support for having no restrictions on the use of tissue from donors with diabetes for DMEK. Trial Registration ClinicalTrials.gov Identifier: NCT05134480
Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative
Bhogal, Maninder, Gupta, Nidhi , Giobellina, Ticiano, Kobayashi, Akira , Males, John , Mehta, Jodhbir S., Romano, Vito , Allan, Bruce, Fogla, Rajesh , Gorovoy, Mark , McKee, Yuri, Koo, Ellen H. , Kocaba, Viridiana , Mejia, Luis Fernando, Moriyama, Aline Silveira , Pereira, Nicolas Cesário , Price, Francis W. , Rapuano, Christopher J. , Rostov, Audrey Talley, Slomovic, Allan R. , Terry, Mark A., Veldman, Peter B., Mehta, Jodhbir Singh , Busin, Massimo , Cursiefen, Claus , Patel, Sanjay V. , Saad, Alain , Sharma, Namrata , Sutton, Gerard L , Tu, Elmer Yuchen , Pineda, Roberto , Vaddavalli, Pravin Krishna
Cornea | December 17, 2024 | Volume: 44 | Issue: 8 | Pages: 1010-1021
Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures. Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting. Consensus was set at 75%, and results with agreement between 70% and 75% were deemed as achieving near consensus. Results: A consensus was reached for 98 statements covering the preoperative, intraoperative, and postoperative aspects of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Four statements achieved near consensus, and consensus could not be achieved for 11 statements. For DMEK, the panel supported a peel technique to prepare tissue for endothelium out DMEK, implanted via an injector and supported by a near full air/gas fill as a baseline procedure onto which more advanced techniques can be built. DMEK tissue should be marked to ensure correct orientation. An inferior peripheral iridotomy should be used to prevent pupil block when a near full air/gas fill in used in endothelial keratoplasty (EK). Descemet stripping automated endothelial keratoplasty was considered preferable to Descemet stripping endothelial keratoplasty where access to microkeratome preparation was available. Conclusions: The Delphi process allowed areas of consensus on the performance of EK to be established by a group of international experts. The statements generated are a helpful framework for novice surgeons learning EK. Further research is needed to help determine what specific tomographic features indicate EK, when guttae are considered visually significant and how to approach combined aphakia and endothelial dysfunction.