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BACKGROUND: To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics METHODS: It was a case control study with 80 eyes each in the diabetic group and the control group. Intraoperative mydriasis, effective phaco time (EPT) and postoperative inflammation were measured. Preoperative, 1 st week, 6 th week and 3 rd month postoperative endothelial cell density (ECD), coefficient of variation (CV), hexagonality and central corneal thickness (CCT) were also measured using Konan noncon robo specular microscope (Model - NSP 9900). RESULTS: In the control group, patients in the age group of 60-69 years were 3.8 times more at risk of ECL compared to patients in the age group of 50-59 years. Patients in whom EPT was ≥0.50 min, were 8.8 times more at risk of ECL when compared to patients in whom EPT <0.25 min. In the diabetic group, patients who had an inflammatory score of 1+ in the first postoperative week; also had 5.7 times more risk of ECL when compared to patients in whom the inflammatory score was 0.5+ in the first postoperative week. There was a significant increase in CV ( p -0.03) and CCT ( p -0.03), significant decrease in the hexagonality ( p -0.01) and no statistically significant difference in the endothelial cell loss (ECL) ( p -0.34) in diabetics after phacoemulsification when compared to controls. CONCLUSION: The present study reveals postoperative inflammation as a risk factor for ECL in diabetics and not intraoperative mydriasis and EPT.

Here, we report a case of acute endothelial graft rejection following coronavirus disease 2019 (COVID-19). A 57-year-old woman who underwent therapeutic penetrating keratoplasty for a perforated infectious corneal ulcer in her right eye developed severe acute respiratory syndrome coronavirus 2 infection, which required intensive care and treatment with steroids. Acute endothelial graft rejection was seen at three weeks postoperatively and managed with high-dose corticosteroids. Despite standard therapy, secondary graft failure was observed. Immune dysregulation associated with COVID-19 may be a significant cause of acute endothelial graft rejection among keratoplasty patients with COVID-19.