Corneal Endothelial Changes In Diabetic And Nondiabetic Patients Undergoing Phacoemulsification Cataract Surgery

The aim of this study is to asses corneal endothelial changes in diabetic versus nondiabetic patients following phacoemulsification cataract surgery

This prospective, case-control study was carried out from October 2023 until February 2024 in KBC Sestre Milosrdnice on patients who underwent phacoemulsification cataract surgery by a single surgeon. 

Patients were matched by age and sex and divided into case group that included 18 patients diagnosed with diabetes mellitus type 2 and control group of 21 patients without diabetes diagnosis. Diabetes was diagnosed prior to hospital admission and patient’s long-term glycemic control was checked preoperatively by HbA1c level. Central corneal thickness (CCT), endothelial cell density (ECD), endothelial cell variance (CV) and hexagonality of endothelial cells were measured by specular microscopy preoperatively and at 1 week and 4 weeks after phacoemulsification cataract surgery and compared between the groups. Statistical methods used were Chi Square test, unpaired t test and paired t test. 

Postoperative CCT measurements were higher in diabetic patients compared to control group, even though the difference was not found statistically significant (p (1 week) = 0,6222, p (4 weeks) = 0,5471). Measured CCT was significantly higher at 1 week postop. compared to preop. measurements in both groups (p=0,0193 in DM group, p=0,0006 in non-DM group), while at 4th postop. week CCT was not significantly higher than preop. measurements. Endothelial cell loss was higher in case group (35,41% compared to 25,24% at 1 week), but the difference wan not found statistically significant (p=0,0939). Diabetic patients had an increase in endothelial cell variance and a decrease in cell hexagonality that was not significantly higher than control group.

The impact of phacoemulsification on corneal endothelial damage is greater in diabetic patients, while their corneal recovery is delayed. More attention should be paid to intraoperative precautions and postoperative care of diabetic patients in cataract surgery.