A Comparative Study Of Corneal Endothelial Cell Structure In Diabetics And Non – Diabetics After Phacoemulsification In An Indian Population.

It is anticipated that by 2030 Diabetes Mellitus ( DM) may afflict up to 79.4 million individuals in India. Chronic hyperglycemia can have an impact on the morphology and function of the various corneal layers, thereby disturbing its transparency.Corneal endothelium chiefly maintains the corneal transparency.The corneal endothelium in diabetic patients is considered a tissue under constant metabolic stress. Any form stress such as surgery is likely to enhance the physiological loss of this endothelial layer, which has no replication properties in humans.  Our study aims to to prospectively compare and evaluate corneal endothelial changes after phacoemulsification among type2 diabetic and nondiabetic patients in an Indian population.

Vivekanada Netralaya , Dehradun , Uttarakhand, India

102 patients (51 DM and 51 Non DM) with senile cataract of age range 45-70 years admitted for phacoemulsification and operated by single surgeon  were included.Fasting Blood sugar, Post Prandial blood sugar and glycosylated haemoglobin were done in these patients. For evaluation of Corneal endothelial cell structure ,Non Contact Specular Microscopy was done and following parameters were compared pre -operatively and post -operatively 1-day, 1-week and 1-month of phacoemulsification was done in both the groups. Following parameters were checked : endothelial cell density (ECD), coefficient of variation (CV) and percentage of polymegathism or hexagonality. Central Corneal Thickenss ( CCT ) was measured using Ultrasound pachymeter.

ECD was affected ,(p value: 0.015), indicating the statistically significant change noted in the endothelial cell density of the diabetic group, compared to , Non- Diabetics, post operatively 1, 1 week, 1 month, and 3 months. Similarly CV (p value :0.047)  and Hexagonality (p value: 0.025) were also significantly affected after phacoemulsification in Diabetic patients. CCT  was also affected significantly during the follow ups (p value 0.014). 

Patients with type 2 DM showed an increase in central corneal thickness and CV and reductions in ECD and hexagonality compared with the healthy controls after Phacoemulsification. As we understand through our study that Diabetes can impact the corneal endothelium at variable levels , it becomes very essential to evaluate the corneal endothelial status in Diabetic patients pre-operatively before planning any intra-ocular procedure.