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Diabetes affects cell density after phacoemulsification
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Individuals with diabetes undergoing cataract surgery experienced more endothelial cell loss than those without diabetes, according to a study.
The aim of the retrospective, nonrandomized cohort study was to evaluate and compare the changes in endothelial cell density in patients undergoing routine phacoemulsification. The analysis included 66 eyes of 55 patients with diabetes and 67 eyes of 65 patients without diabetes, whose cataract surgeries were all performed by the same surgeon during the period between September 2013 and March 2016.
Cumulative dissipated energy (CDE) and percentage of endothelial cell loss served as primary endpoints. No statistically significant difference was seen between the two groups in terms of CDE, nor was there a statistically significant difference between use of BSS or amount of operating room time in patients with or without diabetes. However, percentage of endothelial cell loss at 1 month was 15% in patients with diabetes vs. 11% in those without (P = .03).
In subgroup analysis of patients with diabetes, glucose control as defined by the American Diabetes Association, failed to significantly impact differences in CDE or percentage of endothelial cell loss. – by Rob Volansky
Disclosure: Kendall Donaldson, MD, MS, reports she is a consultant for Alcon, Allergan, Abbott Medical Optics, Allergan, Omeros, TearLab, SUN, Shire. All other authors report no relevant financial disclosures.
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Kathryn M. Hatch, MD
The authors conclude in their study that there is increased endothelial cell loss after cataract surgery in diabetic patients compared to that of well-matched nondiabetic patients. The authors also report that this is the first study to investigate intraoperative parameters that could affect endothelial cell loss, such as cumulative dissipated energy, BSS use and operating room times.
It raises an important concern in that not only are diabetic eyes at increased risk for development of retinal problems such as cystoid macular edema or increased diabetic retinopathy after cataract extraction, but also anterior segment sequelae such as endothelial cell loss.
The clinical relevance of these findings is questionable, however. Unanswered questions are whether the diabetic group has a significant reduction in best corrected visual acuity or increased risk of corneal decompensation. Additionally, other factors potentially affecting endothelial cell loss, such as postoperative intraocular inflammation and medication dosing were not discussed. Future studies assessing these questions as well as the use of the femtosecond laser in this population would be interesting.
Overall a well-written and interesting paper.
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