Corneal endothelial cell changes in patients with diabetes after manual small incision cataract surgery

Abstract

Introduction: Cataract surgery can lead to endothelial cell damage and cell loss. Loss or damage to corneal endothelial cells during surgery may lead to corneal decompensation, causing corneal edema and loss of corneal transparency, which disrupts vision. Specular microscopy provides a non-invasive view of morphology of corneal endothelium. This study was undertaken to evaluate the changes in endothelial cells in patients with diabetes mellitus after manual small incision cataract surgery. Material and methods: Prospective, longitudinal study was conducted in 50 diabetic patients and 50 non-diabetic patients who underwent manual small incision cataract surgery. Endothelial cell density, coefficient of variation, hexagonality and central corneal thickness was assessed using non contact specular microscope preoperatively and 1 week, one month and three months postoperatively. Statistical analysis was done using using t-test. A p-value <0.05 was considered as statistically significant. Results: The mean preoperative endothelial cell density was lower in diabetics as compared to non diabetics (p-value 0.11). There was a statistically significant decrease in endothelial cell density in diabetics post-operatively as compared to non-diabetics (p value: 0.008). There was also a significant increase in corneal thickness in diabetics as compared to non-diabetics (p value: 0.02). The change in coefficient of variation was also higher in diabetic patients (p value: 0.01). However there was no significant change in percentage of hexagonal cells (p-value: 0.74). Conclusion: Diabetic patients have lower endothelial cell density and lower capacity for endothelial repair which increases the risk of decompensation in these patients. Thus, specular microscopy should be performed in every diabetic patient before undergoing cataract surgery, wherever possible and precautions should be taken to protect the corneal endothelium preoperatively.