The relation between the serum level of glycosylated hemoglobin and corneal endothelial cell loss in phacoemulsification

Abstract

Abstract Purpose: To evaluate corneal endothelium (CE) changes and function after uneventful phacoemulsification in relation to the level of glycosylated hemoglobin (HbA1c). Patients and Methods: A prospective interventional case-control study was conducted on 76 eyes, divided into two groups: Group 1 included 38 eyes of diabetic patients, which was further divided into three subgroups according to the level of HbA1c; Group A (strict control HbA1c < 7 mg/dL), Group B (moderate control HbA1c 7–9 mg/dL), and Group C (poorly controlled HbA1c > 9 mg/dL), and Group 2 included 38 eyes of nondiabetic patients. All participants had a full ophthalmological examination, assessment of the level of HbA1c, preoperative evaluation of CE by specular microscopy, uneventful phacoemulsification, and reassessment of CE by specular microscopy 3 weeks after surgery. Results: Three weeks after surgery, statistically significant changes in CE parameters regarding endothelial cell density, ACG, and standard deviation in both groups were found, with greater changes in diabetics. The poorer the control of diabetes (higher preoperative HbA1c), the greater the impact on postoperative CE changes, but the changes were of no statistical significance. Conclusion: Diabetics are more vulnerable to CE damage during phacoemulsification, and the higher the preoperative HbA1c, the more the damage. So, strict preoperative diabetic control is advisable before phacoemulsification.