2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T687,The corneal triple procedure, combining keratoplasty, cataract extraction, and intraocular lens implantation, remains a valuable option for patients with concurrent corneal opacity and cataract. We synthesize historical and contemporary evidence on penetrating keratoplasty (PKP), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK) triple procedures, highlighting their indications, surgical techniques, outcomes, and evolving trends. PKP triple is indicated for full-thickness scarring, keratoconus with central scarring, and cases with anterior segment abnormalities, but remains technically demanding due to open-sky cataract surgery and postoperative refractive unpredictability. ALK triple offers tectonic and visual rehabilitation in stromal disorders sparing the endothelium, though technically challenging. EK triple procedures, particularly Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty, are increasingly preferred in endothelial disorders such as Fuchs endothelial corneal dystrophy, offering faster recovery, more predictable refraction, and better graft survival. Advances in capsulotomy, nucleus management, intraocular lens power calculation, and perioperative strategies have improved safety and refractive outcomes across triple procedures. Long-term studies reveal that although visual and anatomical success rates remain high, complications such as graft rejection, glaucoma, and posterior capsular opacification persist. Careful patient selection and tailored surgical planning are essential, as triple procedures continue to evolve toward safer and more predictable outcomes.31:T4b1,A total 1274 eyes of 982 recipients (mean [SD] age, 70 [8] years; 569 female [57.9%]; 816 [64.1%] with tissue from donors without diabetes and 458 [35.9%] with tissue from donors with diabetes) were included in the study. Preoperatively, mean (SD) central ECD in tissue from donors without diabetes and with diabetes were 2676 (290) cells/mm2 and 2671 (286) cells/mm2, respectively. At 1 year, mean (SD) ECL was 28.3% (16.1%) and 28.0% (17.0%), in the donor groups without and with diabetes, respectively (adjusted mean difference = -0.4%; 95% CI, -2.3% to 1.4%), resulting in a mean (SD) 1-year ECD of 1927 (498) cells/mm2 and 1920 (496) cells/mm2, respectively (adjusted mean difference = 10 cells/mm2; 95% CI, -36 to 56; P = .95). No difference in ECD at 1 year associated with diabetes severity was noted (P = .97). Mean (SD) CV did not differ at 1 year between the 2 groups of eyes (31.5% [4.1%] vs 31.4% [4.1%]; adjusted mean difference = -0.4%; 95% CI, -0.9% to 0.1%; P = .51), and mean (SD) HEX did not differ at 1 year between the 2 groups of eyes (57.7% [5.8%] vs 57.2% [5.8%]; adjusted mean difference = 0.1%, 95% CI, -0.8% to 0.9%; P = .33).32:Ta92,The effect of cornea donor diabetes on endothelial cell density (ECD) and morphometry after Descemet membrane endothelial keratoplasty (DMEK) is not known. To determine whether endothelial cell loss (ECL) and morphometric changes 1 year after successful DMEK are related to cornea donor's diabetes status. This was a multicenter, double-masked, randomized clinical trial conducted from February 2022 to July 2024 at 28 US clinical sites (46 surgeons) and 13 eye banks. Included in the trial were the eyes of recipients (some of whom received tissue from donors without diabetes and others who received tissue from donors with diabetes) who underwent successful DMEK, primarily for Fuchs endothelial corneal dystrophy, and had at least 1 analyzable postoperative endothelial image. DMEK performed with a cornea from a donor without or with diabetes, assigned using a minimization procedure to achieve an approximate 2:1 distribution. ECD, ECL, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX) at 1 year from eye bank and postoperative specular central endothelial images. A total 1274 eyes of 982 recipients (mean [SD] age, 70 [8] years; 569 female [57.9%]; 816 [64.1%] with tissue from donors without diabetes and 458 [35.9%] with tissue from donors with diabetes) were included in the study. Preoperatively, mean (SD) central ECD in tissue from donors without diabetes and with diabetes were 2676 (290) cells/mm2 and 2671 (286) cells/mm2, respectively. At 1 year, mean (SD) ECL was 28.3% (16.1%) and 28.0% (17.0%), in the donor groups without and with diabetes, respectively (adjusted mean difference = -0.4%; 95% CI, -2.3% to 1.4%), resulting in a mean (SD) 1-year ECD of 1927 (498) cells/mm2 and 1920 (496) cells/mm2, respectively (adjusted mean difference = 10 cells/mm2; 95% CI, -36 to 56; P = .95). No difference in ECD at 1 year associated with diabetes severity was noted (P = .97). Mean (SD) CV did not differ at 1 year between the 2 groups of eyes (31.5% [4.1%] vs 31.4% [4.1%]; adjusted mean difference = -0.4%; 95% CI, -0.9% to 0.1%; P = .51), and mean (SD) HEX did not differ at 1 year between the 2 groups of eyes (57.7% [5.8%] vs 57.2% [5.8%]; adjusted mean difference = 0.1%, 95% CI, -0.8% to 0.9%; P = .33). This randomized clinical trial found that ECL and morphometry 1 year after DMEK were not affected by cornea donor diabetes status. With comparable 1-year graft success with tissue from donors with and without diabetes demonstrated in this trial, these findings support the use of corneas from donors with diabetes for endothelial keratoplasty procedures. ClinicalTrials.gov Identifier: NCT05134480.33:T12fc, Importance The effect of cornea donor diabetes on endothelial cell density (ECD) and morphometry after Descemet membrane endothelial keratoplasty (DMEK) is not known. Objective To determine whether endothelial cell loss (ECL) and morphometric changes 1 year after successful DMEK are related to cornea donor’s diabetes status. Design, Setting, and Participants This was a multicenter, double-masked, randomized clinical trial conducted from February 2022 to July 2024 at 28 US clinical sites (46 surgeons) and 13 eye banks. Included in the trial were the eyes of recipients (some of whom received tissue from donors without diabetes and others who received tissue from donors with diabetes) who underwent successful DMEK, primarily for Fuchs endothelial corneal dystrophy, and had at least 1 analyzable postoperative endothelial image. Intervention DMEK performed with a cornea from a donor without or with diabetes, assigned using a minimization procedure to achieve an approximate 2:1 distribution. Main Outcomes and Measures ECD, ECL, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX) at 1 year from eye bank and postoperative specular central endothelial images. Results A total 1274 eyes of 982 recipients (mean [SD] age, 70 [8] years; 569 female [57.9%]; 816 [64.1%] with tissue from donors without diabetes and 458 [35.9%] with tissue from donors with diabetes) were included in the study. Preoperatively, mean (SD) central ECD in tissue from donors without diabetes and with diabetes were 2676 (290) cells/mm 2 and 2671 (286) cells/mm 2 , respectively. At 1 year, mean (SD) ECL was 28.3% (16.1%) and 28.0% (17.0%), in the donor groups without and with diabetes, respectively (adjusted mean difference = −0.4%; 95% CI, −2.3% to 1.4%), resulting in a mean (SD) 1-year ECD of 1927 (498) cells/mm 2 and 1920 (496) cells/mm 2 , respectively (adjusted mean difference = 10 cells/mm 2 ; 95% CI, −36 to 56; P = .95). No difference in ECD at 1 year associated with diabetes severity was noted ( P = .97). Mean (SD) CV did not differ at 1 year between the 2 groups of eyes (31.5% [4.1%] vs 31.4% [4.1%]; adjusted mean difference = −0.4%; 95% CI, −0.9% to 0.1%; P = .51), and mean (SD) HEX did not differ at 1 year between the 2 groups of eyes (57.7% [5.8%] vs 57.2% [5.8%]; adjusted mean difference = 0.1%, 95% CI, −0.8% to 0.9%; P = .33). Conclusions and Relevance This randomized clinical trial found that ECL and morphometry 1 year after DMEK were not affected by cornea donor diabetes status. With comparable 1-year graft success with tissue from donors with and without diabetes demonstrated in this trial, these findings support the use of corneas from donors with diabetes for endothelial keratoplasty procedures. Trial Registration ClinicalTrials.gov Identifier: NCT05134480 34:T4b8,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.35:T9d4,If the success of Descemet membrane endothelial keratoplasty (DMEK) is not affected by whether the donor has diabetes, then the donor pool should expand. To determine whether the 1-year DMEK success rate is affected by the presence of diabetes in the donor. 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. 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. Graft success at 1 year. 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. 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. ClinicalTrials.gov Identifier: NCT05134480.36:T100c, 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 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Fuchs Endothelial Corneal Dystrophy: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Fuchs Endothelial Corneal Dystrophy (condition). Clinician-written summaries and actionable practice insights. 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abstract.","value_numeric":null},{"paper_doi":"10.1016/j.survophthal.2025.12.006","tag_type":"warning","value":"No sample size, comparator groups, or timeframe were reported.","value_numeric":null}],"summaries":{"what_studied":"A narrative synthesis of corneal “triple” procedures—keratoplasty plus cataract extraction and intraocular lens implantation—covering PKP, ALK, and EK with their indications, surgical techniques, outcomes, and trends.","key_result":"EK triple for endothelial disease (e.g., Fuchs) is reported to provide faster recovery, more predictable refraction, and better graft survival; long‑term reports note high visual and anatomic success but ongoing risks of graft rejection, glaucoma, and posterior capsular opacification.","limitations":"Narrative synthesis without described methods or quantitative effect estimates. Heterogeneity across PKP, ALK, and EK indications and techniques limits direct comparison.","practice_takeaway":"Favor EK triple in endothelial disorders to improve recovery speed, refractive predictability, and graft survival; use PKP triple for full‑thickness scarring or complex anterior segment issues, and ALK triple for stromal disease with intact endothelium. Careful patient selection and tailored surgical planning are key to reduce risks such as rejection, glaucoma, and posterior capsular opacification."}},{"doi":"10.1001/jamaophthalmol.2025.4261","pmid":"41105099","title":"Endothelial Cell Loss 1 Year After Successful DMEK in the Diabetes Endothelial Keratoplasty Study","journal_title":"JAMA Ophthalmology","journal_issn":"2168-6165","published_at":"2025-10-17T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12534859/","source_score":53,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-19","doi":"10.1001/jamaophthalmol.2025.4261","days":"30","issn":"2168-6165","rank":"4","field":"Clinical Medicine","score":"53","category":"Ophthalmology","categories":["Ophthalmology"],"_categories":["Ophthalmology"]},"pubmed":{"doi":"10.1001/jamaophthalmol.2025.4261","title":"Endothelial Cell Loss 1 Year After Successful DMEK in the Diabetes Endothelial Keratoplasty Study: A Randomized Clinical 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Accessed August 20, 2025. https://www.federalregister.gov/documents/2025/05/05/2025-07752/recommendations-to-reduce-the-risk-of-transmission-of-disease-agents-associated-with-sepsis-by-human","article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Ophthalmology"],"published-print":{"date-parts":[[2025,12,1]]},"reference-count":24,"published-online":null,"references-count":24,"short-container-title":["JAMA Ophthalmol"],"is-referenced-by-count":2},"unpaywall":{"doi":"10.1001/jamaophthalmol.2025.4253","is_oa":true,"title":"Donor Diabetes and 1-Year Descemet Membrane Endothelial Keratoplasty Success Rate","updated":"2025-12-24T00:55:44+00:00","published_date":"2025-10-17","best_oa_location":{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12534858/","pmh_id":"oai:pubmedcentral.nih.gov:12534858","url_for_pdf":null,"url_for_landing_page":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12534858/"}}},"created_at":"2026-01-11T11:19:33.869Z","updated_at":"2026-01-18T22:40:12.285Z","tags":[{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"category","value":"Ophthalmology","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"condition","value":"Fuchs Endothelial Corneal Dystrophy","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"modality","value":"Endothelial Keratoplasty","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"sample_size","value":"n=1421","value_numeric":1421},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"warning","value":"Allocation used a minimization procedure (comparable with randomization).","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"warning","value":"Outcomes are reported per study eye at 1 year.","value_numeric":null},{"paper_doi":"10.1001/jamaophthalmol.2025.4253","tag_type":"warning","value":"Success estimates reflect eyes with successfully prepared tissue.","value_numeric":null}],"summaries":{"what_studied":"A multicenter, double-masked randomized clinical trial compared 1-year DMEK graft success using corneas from donors with versus without diabetes in low to moderate risk cases (95% Fuchs endothelial corneal dystrophy), with allocation by minimization to an approximate 2:1 ratio. The trial enrolled 1421 study eyes (1097 individuals) from February 2022 to July 2025.","key_result":"One-year graft success was 96.3% (95% CI, 95.0%-97.5%) with non-diabetic donor tissue (912 eyes) versus 97.1% (95% CI, 95.5%-98.4%) with diabetic donor tissue (509 eyes), a 0.7 percentage-point difference (95% CI, -1.2 to 2.6; P=.63). Failures were similar: primary donor failure 23/912 vs 13/509, early surgical failure 6/912 vs 2/509, subsequent failure 3/912 vs 0/509; no failures were due to rejection.","limitations":"Outcomes were reported for eyes with successfully prepared tissue and only to 1 year. Donor diabetes severity subgrouping was based on medical history rather than objective biomarkers.","practice_takeaway":"Donor diabetes status did not affect 1-year DMEK success, including across diabetes severity subgroups, supporting no restrictions on using corneas from donors with diabetes for DMEK."}}],"initialOffset":4,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Fuchs Endothelial Corneal Dystrophy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Fuchs Endothelial Corneal Dystrophy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Fuchs Endothelial Corneal Dystrophy"}}}]]

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