Meta-analysis of corneal endothelial changes after phacoemulsification in diabetic and non-diabetic patients

Abstract

Background Currently, there is still controversy about the differential changes in corneal endothelium function and morphology after phacoemulsification between Diabetes Mellitus (DM) and non-Diabetes Mellitus (non-DM) patients. In this study, we aimed to evaluate the influence of phacoemulsification on the corneal endothelium in DM and non-DM patients. Methods Databases of PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies published between January 1, 2011 and December 25, 2021. The weighted mean difference and 95% confidence interval were used to estimate the outcomes of statistical analyses performed. Results Thirteen studies involving 1744 eyes were included in this meta-analysis. No significant difference was observed in the central corneal thickness (CCT), endothelial cell density (ECD), coefficients of variation (CV), or hexagonal cell percentage (HCP) between the DM and non-DM groups (CCT: P = 0.91; ECD: P = 0.07; CV: P = 0.06; HCP: P = 0.09) preoperatively. The CCT was significantly thicker in the DM group at 1 month (P = 0.003) and 3 months (P = 0.0009) postoperatively, and there was no significant difference at 6 months postoperatively (P = 0.26) than non-DM group. The CV was significantly higher and HCP was significantly lower in the DM group at 1 month (CV:P < 0.0001, HCP: P = 0.002), with no significant difference at 3 months (CV: P = 0.09, HCP: P = 0.36) and 6 months (CV: P = 0.32, HCP: P = 0.36) postoperatively than non-DM group. DM patients had lower ECD than non-DM patients at all postoperative time points (1 month, 3 months: P < 0.00001, 6 months: P < 0.0001). Conclusions The influence of phacoemulsification on corneal endothelial damage is greater in diabetic patients. Moreover, the recovery of corneal endothelial function and morphology is delayed in these patients. Clinicians should be more attentive to the corneal health of DM patients when considering phacoemulsification.

Corneal topographic indices of scheimpflug camera in type 2 diabetic and non-diabetic elderly populations

“…Several studies compared central corneal thickness between the diabetic and non-diabetic groups [ 18 ]. Although a number of studies found that diabetic patients had thicker corneas compared to non-diabetic subjects, [ 19 , 20 ] some other studies did not report any difference between the two groups [ 5 , 19 ].…”

“…The chronic hyperglycemic state of diabetes can damage many body organs such as the eyes, nerves, kidneys, heart, and blood vessels over time [ 2 ]. Although diabetic retinopathy (DR) is the most serious ocular complication of diabetes and one of the causes of secondary blindness during adulthood, [ 3 ] studies have shown that this disease also leads to changes in the anterior eye segment, especially the cornea [ 4 , 5 ].…”