Outcomes of phacoemulsification on the corneal endothelium in diabetic versus non-diabetic patients: a prospective non-randomized controlled interventional study

Abstract

Background: 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

Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research

“…Our comprehensive search for similar studies revealed 37 studies ( Table 1 ) [ 8 , 10 – 45 ]. Given the long study period (27 years), the cohorts differed in terms of phacoemulsification machines and parameters: for example, while longitudinal mode was used in the older studies and still predominated in the more recent studies, torsional and transversal modes have become increasingly favored ( S1 Table ).…”

“…Identifying preoperative or surgical risk factors for endothelial-cell loss (ECL) after cataract surgery could improve outcomes: it could help determine which patients will require additional care or alternative treatment strategies and/or promote the development of new endothelial cell-sparing technical approaches. Our comprehensive analysis of the literature published since 1995 revealed a large field composed of 37 studies that have searched for such risk factors ( Table 1 ) [ 8 , 10 – 45 ]. However, all have significant limitations.…”

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