Comparative Evaluation of Corneal Endothelium in Diabetic Patients Undergoing Phacoemulsification

To determine if phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetics.

This study compared the endothelial status in 60 diabetics with good glycemic control and 60 nondiabetics before and after uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality and percentage coefficient of variation (%CV) were measured using a specular microscope.

Data were age and sex matched. Diabetics showed significantly higher loss in endothelial cell count as compared to nondiabetics. At the end of 3 months, there was a decline of 157 endothelial cell (standard deviation [SD] 90) in the diabetic group and 121 (SD 50) in the control group. This was statistically significant (P = 0.008). Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the %CV. The change in %CV was 4.5 in the control group and 3.1 in diabetic group which was statistically significant (P = 0.016). Significant correlation was found between energy used and change in endothelial count as well as %CV in nondiabetics only.

In spite of good glycemic control, diabetics have significantly more endothelial damage in comparison to nondiabetics with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in diabetics.