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Endothelial cell loss higher in cataract patients with diabetes
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WAILEA, Hawaii — Clinicians should preoperatively discuss the effects of cataract surgery, specifically endothelial cell loss, with high-risk patients with diabetes, according to a speaker here.
A recent study found patients with diabetes had a 15% endothelial cell loss during cataract surgery compared with 11% in patients without diabetes, with the percent decrease in the diabetes group being statistically higher than in the group without diabetes, Kendall E. Donaldson, MD, MS, said at Hawaiian Eye 2018.
The study examined 120 patients and had tight exclusion and inclusion criteria and a careful patient match for age, cataract grade, axial length and preoperative endothelial cell density.
“One of the things we don’t really talk about all that much is endothelial cell loss during cataract surgery. It is well known that diabetics tend to have a lower endothelial cell count to start with,” Donaldson said.
Results of the study showing patients with diabetes lose more endothelial cells should encourage ophthalmologists to discuss the possibility of a delayed recovery for these patients.
“Sometimes it’s more difficult to discuss some of these more challenging things and it’s nice to only discuss the positive things in surgery, but it’s worth having this discussion preoperatively,” she said.
In addition, clinicians should be careful with reducing anti-inflammatories during surgery for higher-risk patients and use the tools available to ensure safer surgery for these patients.
“We have so many adjunctive tools to facilitate our surgeries, such as Malyugin rings, intraoperative phenylephrine/ketorolac and even femtosecond-assisted cataract surgery to help decrease the energy we are putting into these eyes with cataract surgery,” Donaldson said. “This is 20% of our cataract surgery population, so we really need to pay special attention to these patients who are at risk.” – by Rebecca L. Forand
Reference: Donaldson KE. The effect of diabetes on cataract surgery outcomes. Presented at: Hawaiian Eye 2018; Jan. 13-19, 2018; Wailea, Hawaii.
He X, et al. Cornea. 2017;doi:10.1097/ICO.0000000000001245.
Disclosure: Donaldson reports she is a consultant for or receives funding from Alcon, Allergan, Bausch + Lomb, Johnson & Johnson, NovaBay, Omeros, Quidel, Shire and Sun.