To assess and compare the endothelial cell changes after cataract extraction by phacoemulsification and PCIOL implantation in type II diabetic patients versus age group matched non-diabetic patients

• Author Details:   
• Abhishek Sagar ^*
• Ashok Rathi
• Rajender Singh Chauhan
• Gautam Jain
• Sonam Gill
• Yogesh Malik

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Background: Diabetes mellitus–related metabolic alterations compromise corneal endothelial integrity and reduce its functional reserve, making diabetic eyes particularly susceptible to endothelial cell loss and morphological changes during phacoemulsification. This study evaluates these specular microscopy parameters in North Indian type II diabetics versus non‑diabetic controls to elucidate the impact of diabetes on postoperative endothelial health.

Aim and Objectives: To assess and compare the endothelial cell changes after Phacoemulsification with PCIOL in type II diabetic patients versus age group matched non-diabetic patients.

Materials and Methods: This comparative prospective observational follow-up study included 50 diabetic patients and 50 control patients without diabetes who underwent phacoemulsification with PCIOL. Preoperative, one day, one week, one month and three months post-surgery assessments of corneal endothelial cell changes were done using specular microscopy.

The software used for the statistical analysis was SPSS (statistical package for social sciences) version 25.0 and MedCalc software. The quantitative variables in both groups were expressed as mean ± SD and compared using STUDENT T test. The p-value was taken significant when less than 0.05 (p<0.05) and confidence interval of 95% was taken.

Results: One hundred eyes (57% male; mean age 60.8 ± 5.0 years [diabetics] vs. 60.4 ± 5.0 years [controls]) were enrolled. Preoperatively, diabetic corneas were significantly thicker (mean CCT 523.3 ± 31.1 µm vs. 502.5 ± 37.0 µm; p = 0.003) and had lower hexagonality (50.3 ± 3.5% vs. 56.1 ± 12.8%; p = 0.003), while endothelial cell density (ECD) and coefficient of variation (CV) did not differ.

Following phacoemulsification, both groups showed transient CCT increases, but diabetics maintained significantly higher CCT at day 1, week 1, month 1 and month 3 (all p < 0.05). By 3 months post-op, ECD had declined in both groups, with a greater loss in diabetics (−531 cells/mm² vs. −511 cells/mm²; p < 0.001). CV rose and hexagonality fell in both cohorts after surgery; however, diabetics experienced significantly larger postoperative increases in CV and decreases in hexagonality at all follow-up points (all p < 0.01).

These data indicate that diabetic corneas exhibit thicker baseline CCT, reduced hexagonality and a more pronounced endothelial response—manifested as sustained edema, greater cell loss and morphological derangement—after phacoemulsification.

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Conclusion: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after Phacoemulsification than the normal corneal endothelium.