Corneal Endothelial Outcomes in Diabetic Patients Following Repeated Anterior Chamber Paracentesis

The aim of this study was to evaluate longitudinal changes in corneal endothelial morphology following serial anterior chamber (AC) paracentesis in patients with type 2 diabetes mellitus.

This is a prospective cohort study with both cross-sectional and longitudinal components. Participants with type 2 diabetes mellitus underwent bilateral AC paracentesis, specular microscopy analysis, and dilated fundus examination at baseline and at four-month intervals over 3 years. Endothelial parameters included cell density (CD), coefficient of variation, hexagonality, and central corneal thickness. Linear mixed-effects models were adjusted for age, sex, laterality, hemoglobin A1c, diabetes duration, diabetic retinopathy severity, and lens status.

One hundred twelve participants were included at baseline [median age 63 years, 50% female, median hemoglobin A1c 7.8% (interquartile range 1.93), median diabetes duration 20 years]. Most had mild-to-moderate nonproliferative DR (60%), and 30% were pseudophakic. At baseline, pseudophakic lens status (mean ± SD CD: 2566.7 ± 190.8 cells/mm2) predicts a lower CD of -161 cells/mm2 (95% confidence interval -243.1 to -83.1) compared with phakic eyes (2721.5 ± 184.1 cells/mm2). Pseudophakia also predicts a higher coefficient of variation of +3.7 (95% confidence interval, 0.2-7.0). These differences persisted longitudinally. Repeated AC paracentesis was not associated with any significant change in any parameters.

To our knowledge, this is the largest and longest prospective evaluation of repeated AC paracentesis in humans with diabetes. Despite up to 10 AC paracenteses per eye over 3 years, no adverse effects on endothelial cell morphology were observed. These findings support the broader adoption of serial aqueous sampling as a precision-medicine tool in ophthalmology and research.