Corneal structure and endothelial morphological changes after uneventful phacoemulsification in type 2 diabetic and nondiabetic patients

Beato, João; Esteves-Leandro, João; Reis, David; Falcão, Manuel; Rosas, Vitor; Carneiro, Ângela; Reis, Fernando Falcão

doi:10.5935/0004-2749.20210071

Cited by 8 publications

(12 citation statements)

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“…Decreased innervation, exposure to vitreous humor [ 32 ], increased hardness of lens nucleus [ 14 ], surgical trauma [ 33 ], intraoperative inflammatory response [ 15 ], and postoperative corneal edema [ 34 ] are important risk factors for CECs damage after phacoemulsification. However, the risk of CECs injury caused by the above factors increases in diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

“…The percentage of endothelial cell loss (ECL%) in patients with DM was reported to be significantly higher than that in the control group after phacoemulsification [ 41 , 42 ], and the damage was not restored to the preoperative state at 6 months postoperatively [ 14 ]. Joo et al [ 43 ] found that the ECL in patients with DM was higher than that in non-DM patients 1 year after phacoemulsification, although not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Although the ECL% in patients with DM was higher than that in the control group after phacoemulsification, the intraoperative cumulative dissipated energy (CDE), fluid consumption, and operative time were not statistically significant [ 41 ]. The higher ECL postoperatively may be related to the advanced age of patients, increased cataract density, increased endothelial cell vulnerability in diabetic patients, increased trauma during cataract surgery, and grade of cataract [ 14 , 16 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, some studies reported that the CV of patients with DM was significantly higher than that of those without DM at 3 months postoperatively, although this difference did not affect the corneal function [ 19 ]. The HCP returned to its preoperative state 6 months postoperatively [ 14 ]. No significant change was found in the CV and HCP in either group at 1 year postoperatively [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…Any injury that causes loss or damage to the corneal endothelial cells may threaten vision, including traumatism or intraocular surgery [ 8 ]. Moreover, the presence of diabetes in elderly patients undergoing cataract surgery makes them even more vulnerable to greater endothelial damage, a hypothesis that has been demonstrated by several studies [ 9 , 10 , 11 , 12 , 13 ]. They are five times more likely than non-diabetic to develop cataract at an early age.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients

et al. 2023

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The aim of this study was to evaluate the influence of phacoemulsification cataract surgery on the state of the corneal endothelium in diabetic versus non-diabetic patients. We compared the corneal cell morphology in 48 diabetics with good glycemic control and 72 non-diabetic patients before and after uneventful phacoemulsification. Corneal cell density, central corneal thickness, and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of age, gender, axial length, and anterior chamber depth on the parameters of the corneal endothelium were evaluated. We noticed a drop in the endothelial density in both groups postoperatively: a mean endothelial cell loss of 472.7 ± 369.1 in the diabetic group was recorded versus 165.7 ± 214.6 mean loss in the non-diabetic group after the first week. A significant increase in central corneal thickness was also noticed in both groups one week after phacoemulsification, but no statistical significance after 4 weeks in the diabetic group. In terms of cell hexagonality, statistically significant differences were noticed after 4 weeks in both groups. Overall, a significant difference between diabetic and non-diabetic population was noticed in terms of corneal endothelial cell loss after uneventful phacoemulsification cataract surgery. Routine specular microscopy and HbA1c evaluation is recommended before cataract surgery, while intraoperative precautions and high monitorisation in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances are essential to reduce the risk of endothelial damage.

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Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery

et al. 2023

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Purpose This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. Methods A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. Results After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81–592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62–1803.23). Conclusions Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. Trial registration It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.

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Corneal structure and endothelial morphological changes after uneventful phacoemulsification in type 2 diabetic and nondiabetic patients

Cited by 8 publications

References 0 publications

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

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

Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients

Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery

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