Risk factors for endothelial cell damage in diabetics after phacoemulsification

Abstract

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.

Comparison of corneal endothelial cell changes after phacoemulsification between type 2 diabetic and nondiabetic patients

“…The reason for this is that, unlike previous studies, this study observed a relatively extended period of 1 year after surgery, and as a result, it is assumed that the central ECD recovered due to stabilization of the endothelium following a period of rearrangement. [ 31 , 32 ] According to the recently reported studies of Ganesan et al [ 13 ] and Fernández-Muñoz et al, [ 14 ] ECD loss at 3 months after cataract surgery did not differ between diabetes and control groups. Further studies with large sample sizes are required.…”

Comparative study of outcome of cataract surgery in diabetic and non-diabetic patients

“…The cornea has been reported to be thicker in eyes of diabetic patients than in eyes of non-diabetic subjects. 8 Cataract extraction and IOL implantation causes trauma to the already compromised corneal endothelium and causes corneal edema. Hence compared with non-diabetic patients, eyes of diabetic patients showed more damage in corneal endothelial cells after cataract surgery and a delay in the post-operative recovery of corneal edema.…”

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

“…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.…”

“…Oxidative stress not only directly damages CECs [ 29 ] but also induces inflammation through multiple activation pathways [ 40 ]. Corneal edema alleviates with a decrease in inflammation, resulting in a lower CCT during the recovery process after phacoemulsification [ 15 ].…”