Corneal Endothelial Changes After Phacoemulsification Using the Eight-Chop Technique in Diabetic Eyes

Abstract

Background/Objectives: To analyze corneal endothelial changes and intraocular pressure (IOP) after phacoemulsification combined with the eight-chop technique and intraoperative parameters in patients with diabetes mellitus. Methods: The eyes of patients with cataracts who underwent phacoemulsification were analyzed in this study. Based on their hemoglobin A1c levels, patients were divided into two groups. The eight-chop technique was used for cataract surgery. The operative time, the phaco time, the aspiration time, the cumulative energy dissipated, and the volume of fluid used were determined. Best corrected visual acuity, IOP, corneal endothelial cell density (CECD), central corneal thickness (CCT), coefficient of variation (CV), and percentage of hexagonal cells (PHC) were recorded before and after surgery. Results: Overall, 181 eyes of 138 patients with cataracts were evaluated. In the diabetes group, the CECD loss rates were 5.1%, 3.9%, and 2.1% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. In the control group, the CECD loss rates were 2.8%, 2.6%, and 1.2% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. Significant differences in the percentage decrease in CECD were observed between the two groups at 7 and 19 weeks postoperatively. Significant differences in the CV and PHC were observed preoperatively and postoperatively between the diabetes and control groups (p < 0.01 or p = 0.01, 0.02). Significant differences were also observed between CV and PHC preoperatively, at 19 weeks, and 1 year postoperatively in the diabetes and control groups (p < 0.01). At 1 year postoperatively, IOP reduction rates were 8.0% and 11.2% in the diabetes and control groups, respectively. Conclusions: CECD loss was minimal with the eight-chop technique; however, the diabetes group showed a higher percentage decrease than the control group up to 19 weeks postoperatively. In addition, although IOP decreased in both groups after surgery, the percentage decrease was significantly different at 1 year postoperatively. This study suggests that the corneal endothelial cells of diabetic eyes may be more fragile than those of normal eyes and that the long-term postoperative IOP-lowering effect may be attenuated. These findings will contribute to advances in personalized treatment strategies for patients with diabetes.

Keywords: cataract surgery; corneal endothelial cell; diabetes mellitus; eight-chop technique; phacoemulsification.