Corneal cell density loss greater in patients with diabetes after cataract surgery
Click Here to Manage Email Alerts
Key takeaways:
- Endothelial cell loss was higher in diabetic vs. nondiabetic patients after phacoemulsification.
- The percentage of hexagonal cells also dropped in both groups, with significant differences at weeks 1 and 4.
Patients with diabetes had significantly greater endothelial cell loss after phacoemulsification cataract surgery compared with their nondiabetic counterparts, according to data published in Diagnostics.
“Our results revealed a reduction in the number of endothelial cells, highlighting the fact that cataract surgery is a traumatic procedure for the cornea, regardless of the presence or absence of diabetes,” Adela-Laura Ciorba, from the University of Oradea in Romania, and colleagues wrote. “We also noticed an increase in the central corneal thickness in both groups after surgery, with a greater statistical significance in the first week post phacoemulsification, while the percentage of hexagonal cells dropped in both groups after surgery, with a greater difference observed at week 4.”
In a cross-sectional, retrospective study of 120 eyes from 120 patients, researchers compared corneal endothelium alterations of 48 diabetic patients with 72 nondiabetic patients, evaluating participants’ corneal cell density, central corneal thickness and hexagonality before and after phacoemulsification surgery.
The researchers reported that those in the diabetic group had significantly higher endothelial cell loss compared with the nondiabetic group 1 week after surgery (472.7 vs. 165.7, respectively).
“It is also important to underscore the fact that diabetic patients lost more endothelial cells, progressively, from the 1st week postsurgical visit to the 4th week follow-up evaluation compared to their nondiabetic counterparts,” Ciorba and colleagues wrote.
No significant difference was found in central corneal thickness between the two groups, with researchers reporting a significant increase in this metric in both groups, particularly in the first week after surgery.
Conversely, the percentage of hexagonal cells dropped in both groups, with a statistically significant difference between groups noted at week 1 (P < .05) and week 4 (P < .01) after surgery.
“We strongly recommend routine specular microscopy and HbA1c evaluation before all cataract surgeries,” Ciorba and colleagues wrote. “Regarding intraoperative precautions, a high level of monitoring is necessary in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances to reduce the risk of endothelial damage for a successful surgical procedure.”
Perspective
Back to Top
Jacqueline M Hallauer, OD, FAAO
Although cataract surgery is not performed by optometrists, it makes up for a sizable portion of our day-to-day practice. It is imperative that we recognize the toll that cataract surgery takes on the posterior aspect of the cornea.
During our training, we learned that cataract surgery will cause a moderate decrease in our corneal endothelial cells as well as a decrease in cell hexagonality. However, when referring patients for surgery, are we considering the impact to the posterior cornea when evaluating the risks vs. benefits?
This study does an excellent job discussing corneal changes associated with phacoemulsification cataract surgery in patients with vs. without diabetes. It was concluded that there was a significant difference in cell density and cell hexagonality between patients with and without a diabetes diagnosis.
However, there are a few areas where the study is lacking, one of which is that the sample of patients with diabetes was well controlled, with HbA1c less than 7% for the last decade and the duration of the study, which they mention as a shortcoming in the publication.
Overall, this study was presented in a fashion that was easy to read, comprehend and assimilate. The images and graphs were presented in a manner that was easy for the reader to digest.
Collapse
Read more about
Click Here to Manage Email Alerts