Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study
Medical Hypothesis, Discovery & Innovation in Optometry,
Vol. 2 No. 1 (2021),
16 June 2021
AbstractBackground: Cataract surgery in patients with diabetes is indicated either to improve visual acuity or to allow assessment and treatment of fundus changes. We aimed to document the effects of phacoemulsification on the corneal endothelium in patients with or without diabetes.
Methods: This comparative, prospective, non-randomized controlled interventional study was conducted in patients with visually significant immature senile cataracts in the ophthalmology department at Sohag University Hospital between January 2018 and December 2020. The following data were recorded: corrected distance visual acuity, keratometry readings, refraction, slit lamp examination results, and biometry data. Changes in corneal parameters were documented preoperatively and at 1, 3, and 6 months postoperatively using specular microscopy.
Results: Sixty-four eyes of 64 patients with visually significant senile cataracts were included (32 eyes in the diabetic group and 32 eyes in the non-diabetic control group). We found greater mean endothelial cell loss in the non-diabetic group (179 cells/mm2; 6.4%) than in the diabetic group (134 cells/mm2; 4.8%) at 3 months postoperatively, yet the difference was not significant. The difference could be explained by the higher mean cumulative dissipated energy (CDE) used in the non-diabetic group (5.37 J) than in the diabetic group (4.68 J), although the difference was also not significant. Moreover, we found significantly higher coefficient of variation (CV) in the non-diabetic group than in the diabetic group at 1, 3, and 6 months postoperatively (P = 0.03, P = 0.02, and P = 0.008, respectively).
Conclusions: Endothelial cell density was directly related to the CDE of phacoemulsification and not to diabetes. CV was significantly higher in the non-diabetic group than in the diabetic group. Future studies with a larger sample size, longer follow-up, and more diabetic subgroups with different levels of glycemic control are warranted to verify our conclusions.
How to cite this article: Mahmoud A, Moussa I, Abozaid M, Iqbal M. Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study. Med Hypothesis Discov Innov Optom. 2021 Spring; 2(1): 1-7. DOI: https://doi.org/10.51329/mehdioptometry119
- cumulative dissipated energy
- cataract surgery
- diabetes mellitus
- corneal endothelium
- specular microscopy
- endothelial cell density
- coefficient of variation
- central corneal thickness
Memon AF, Mahar PS, Memon MS, Mumtaz SN, Shaikh SA, Fahim MF. Age-related cataract and its types in patients with and without type 2 diabetes mellitus: A Hospital-based comparative study. J Pak Med Assoc. 2016;66(10):1272-6. pmid: 27686302
Abib FC, Hida RY, dos Santos RM. Corneal Endothelium: Histology, Physiology and In-vivo Examination with Specular Microscope. JSM Ophthalmol. 2017;5(4):1063.
Praveen MR, Vasavada AR, Shah GD, Shah AR, Khamar BM, Dave KH. A prospective evaluation of posterior capsule opacification in eyes with diabetes mellitus: a case-control study. Eye (Lond). 2014;28(6):720-7. doi: 10.1038/eye.2014.60 pmid: 24675577
Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal changes after small-incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. 2004;122(7):966-9. doi: 10.1001/archopht.122.7.966 pmid: 15249359
Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB, Thulesen J. Corneal endothelial cell changes associated with cataract surgery in patients with type 2 diabetes mellitus. Cornea. 2011;30(7):749-53. doi: 10.1097/ICO.0b013e31820142d9 pmid: 21317781
Sudhir RR, Raman R, Sharma T. Changes in the corneal endothelial cell density and morphology in patients with type 2 diabetes mellitus: a population-based study, Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS, Report 23). Cornea. 2012;31(10):1119-22. doi: 10.1097/ICO.0b013e31823f8e00 pmid: 22357387
Storr-Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2014;92(2):158-60. doi: 10.1111/aos.12064 pmid: 23387877
Khalid M, Hanif MK, Islam QU, Mehboob MA. Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus. Pak J Med Sci. 2019;35(5):1366-9. doi: 10.12669/pjms.35.5.596 pmid: 31489008
Ganesan N, Srinivasan R, Babu KR, Vallinayagam M. Risk factors for endothelial cell damage in diabetics after phacoemulsification. Oman J Ophthalmol. 2019;12(2):94-8. doi: 10.4103/ojo.OJO_200_2017 pmid: 31198294
Chylack LT, Jr., Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, et al. The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol. 1993;111(6):831-6. doi: 10.1001/archopht.1993.01090060119035 pmid: 8512486
Sahu PK, Das GK, Agrawal S, Kumar S, Kumar N. Comparative Evaluation of Corneal Endothelium in Diabetic Patients Undergoing Phacoemulsification. Middle East Afr J Ophthalmol. 2017;24(4):195-201. doi: 10.4103/meajo.MEAJO_212_16 pmid: 29422754
Beato JN, Esteves-Leandro J, Reis D, Falcao M, Rosas V, Carneiro A, et al. Evaluation of Corneal Structure and Endothelial Morphological Characteristics in Type 2 Diabetic and Non-Diabetic Patients. Clin Ophthalmol. 2020;14:1993-9. doi: 10.2147/OPTH.S256244 pmid: 32764865
Budiman B. Comparison of Endothelial Cell Density, Morphological Changes and Central Corneal Thickness after Phacoemulsification between Diabetic and Non-Diabetic Patients. The Open Ophthalmology Journal. 2020;14(1):15-20. doi:10.2174/1874364102014010015
Abdeen A, Hanifa H, Awad A, Hussein A. Changes in Corneal Endothelium after Phacoemulsification in Diabetic and Non-diabetic Cataract Patients in Zagazig University Hospitals. Zagazig University Medical Journal. 2020. doi: 10.21608/zumj.2020.44499.1959
Tang Y, Chen X, Zhang X, Tang Q, Liu S, Yao K. Clinical evaluation of corneal changes after phacoemulsification in diabetic and non-diabetic cataract patients, a systematic review and meta-analysis. Sci Rep. 2017;7(1):14128. doi: 10.1038/s41598-017-14656-7 pmid:29074989
Misra SL, Goh YW, Patel DV, Riley AF, McGhee CN. Corneal microstructural changes in nerve fiber, endothelial and epithelial density after cataract surgery in patients with diabetes mellitus. Cornea. 2015 Feb;34(12):177-81. doi: 10.1097/ICO.0000000000000320. Erratum in: Cornea. 2015 Dec;34(12):e40 pmid: 25474233
Wang B, Li J, Wang Y, Wu B, Huo J. Clinical effect analysis of phacoemulsification on cataract patients with diabetes mellitus. International Eye Science. 2013;13:1163-6.
- Abstract Viewed: 119 times
- Full Text PDF Downloaded: 38 times