Abstract
Corneal endothelium morphological abnormalities result in fluid imbalance, stromal swelling, and loss of transparency, thus impairing visual function. Recently, growing number of studies have focused on diabetic corneal abnormalities after cataract surgery and its comparison with non-diabetic patients, the results remain conflicting. Thus, to evaluate the effect of phacoemulsification on the corneal properties in diabetic and non-diabetic patients, prospective studies were comprehensively searched through PubMed, EMBASE, and Cochrane databases updated to Jan 2017. A meta-analysis of the 13 identified studies was performed using weighted mean difference (WMD) and 95% confidence interval (CI). For the dynamic changes between preoperative and postoperative values, significant differences were identified between the two groups in endothelial cell density (ECD) and hexagon cells (HC%) at 1 day, 1 week, 1 month, and 3 months postoperatively, in central corneal thickness (CCT) at 1 month postoperatively, and in coefficient variation (CV) at 1 week and 1 month postoperatively. However, no significant differences were observed in CCT at 1 day, 1 week and 3 months postoperatively or in CV at 1 day and 3 months postoperatively. Diabetic corneas are more vulnerable to stress and trauma, resulting in greater morphological abnormalities and longer recovery time.
Highlights
As of 2015, an estimated 415 million people had diabetes worldwide[1], which is almost 1.5 times greater than in 2010 (285 million)
18 studies were excluded after full-text reading: four on extracapsular cataract extraction (ECCE), two on manual small incision cataract surgery (MSICS) which is different from phacoemulsification from either the incision size or the surgical method, five retrospective studies, five with unavailable data, one that was a poster, and one that was a review
Inoue et al.[38] investigated 1394 patients before cataract surgery and their multiple regression analysis revealed that age instead of diabetes mellitus (DM) was the only variable relevant to endothelial cell density (ECD), coefficient of variation (CV), and HC%
Summary
As of 2015, an estimated 415 million people had diabetes worldwide[1], which is almost 1.5 times greater than in 2010 (285 million). In a complex disease environment, cataract surgery with phacoemulsification and lens implantation leads to larger endothelial cell loss in diabetic corneas[14,15,16,17,18]. The corneal endothelium can be adversely affected by surgery due to factors like lens nuclear sclerosis, effective phacoemulsification time (EPT), phacoemulsification energy, and IOL implantation[15,19,20,21]. These factors coupled with the effect of DM indicate a great risk of long-term endothelium cell dysfunction with decompensation and the development of bullous keratopathy[22]. Abnormal corneal endothelial cell morphology coupled with increased CCT25 is another marker of endothelial cell dysfunction, which results in fluid imbalance, stromal swelling, and loss of transparency, impairing visual function
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