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 ۲۰۱۸ and December ۲۰۲۰. 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 ۱, ۳, and ۶ months postoperatively using specular microscopy. Results: Sixty-four eyes of ۶۴ patients with visually significant senile cataracts were included (۳۲ eyes in the diabetic group and ۳۲ eyes in the non-diabetic control group). We found greater mean endothelial cell loss in the non-diabetic group (۱۷۹ cells/mm۲; ۶.۴%) than in the diabetic group (۱۳۴ cells/mm۲; ۴.۸%) at ۳ 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 (۵.۳۷ J) than in the diabetic group (۴.۶۸ 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 ۱, ۳, and ۶ months postoperatively (P = ۰.۰۳, P = ۰.۰۲, and P = ۰.۰۰۸, 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. Keywords: phacoemulsification intraocular cumulative dissipated energy cataract surgery diabetes mellitus corneal endothelium diabetic non-diabetic specular microscopy endothelial cell density coefficient of variation central corneal thickness