CORNEAL ENDOTHELIAL CELL LOSS AFTER SMALL INCISION CATARACT SURGERY IN DIABETIC VERSES NON DIABETIC PATIENTS

  • Dr N. G. Raut Professor, Dept; Of Ophthalmology, Indira Gandhi Govt; Medical College, Nagpur, India
  • Dr Ravi Chauhan Associate Professor, Dept; Of Ophthalmology, Indira Gandhi Govt; Medical College, Nagpur, India
  • Dr Sandesh Sonarkhan Indira Gandhi Govt; Medical College, Nagpur, India
Keywords: diabetes, corneal endothelium, endothelial cell loss, small incision cataract surgery, specular microscopy

Abstract

Rationale : This study was undertaken to assess the postoperative endothelial cell loss, change in endothelial cell morphology and central corneal thickness in patients with type II diabetes undergoing manual SICS and to compare them with age-matched normal individuals.

Method: The present study is a prospective, comparative study carried out at a tertiary care hospital which aims to assess and compare the endothelial cell loss and changes in central corneal thickness after manual small incision cataract surgery in patients with type II diabetes versus age-matched normal individuals.

Result: A total of 100 eyes of 100 individuals with type II diabetes and 100 eyes of 100 age matched normal individuals in the age group of 50-80 years were studied The endothelial cell loss at 3 months in cases was 22.01 ± 10.49% and in controls was 16.64 ± 6.72% with a significant difference indicating increased vulnerability of corneal endothelium in diabetics to intraocular surgical stress.
• Coefficient of variation of cell size and percentage of hexagonal cells, being indicators of repair after cataract surgery were not found to be significantly different in cases and controls.
• Central corneal thickness was maximum at the first follow up at 2 weeks in both the groups, and then gradually decreased. CCT was significantly raised in diabetics in all the follow-ups indicating a slower resolution of postoperative corneal edema in diabetics.

Conclusion: Postoperatively, there was a significant endothelial cell loss between cases and controls at 3 months. Therefore, in spite of a good glycemic control and no corneal abnormalities before surgery, the endothelium in diabetic subjects was found to be more vulnerable to surgical trauma and also having a lower capability in the process of repair. This suggests that eyes of diabetic patients are under metabolic stress and have corneal endothelium with lower reserve ability than non diabetic eyes. Therefore, surgery should be planned with appropriate precautions in diabetic patients.

Downloads

Download data is not yet available.

References

1. Sanchez-Thorin JC. Ophthalmic Complications of Diabetes Mellitus. International Ophthalmology Clinics. Vol 38 ed. Philadelphia, PA: LippincotRaven; 1998. Yee RW, Matsuda M, Schultz RO, et al. Changes in the normal corneal endothelial cellular pattern as a function of age. Curr Eye Res.1985;4(6):671–678.
2. Morikubo S, Takamura Y, Kubo E, et al. Corneal changes after small incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. 2004;122(7):966–969.
3. Furuse N, Hayasaka S, Yamamoto Y, et al. Corneal endothelial changes after posterior chamber intraocular lens implantation in patients with or without diabetes mellitus. Br J Ophthalmol. 1990;74(5):258–260.
4. Gipson IK, Friend J, Spurr-Michaud SJ. Transplant of corneal epithelium to rabbit corneal wounds in vivo. Invest Ophthalmol Vis Sci. 1985;26(4):425–33.
5. Maurice DM .The structure and transparency of the corneal stroma. J Physiol. 1957;136(2):263–86.
6. Meek KM, Boote C.The organization of collagen in the corneal stroma. Exp Eye Res. 2004;78(3):503–12.
7. Newton RH, Meek KM. The integration of the corneal and limbal fibrils in the human eye. Biophys J. 1998;75(5):2508–12.
8. Jester JV, Barry PA, Lind GJ, et al. Corneal keratocytes: in situ and in vitro organization of cytoskeletal contractile proteins. Invest Ophthalmol Vis Sci. 1994;35(2):730–43.
9. Sugar A, Fetherolf E, Lin LLK, Ostbaum SA, Galin MA. Endothelial cell loss from intraocular lens insertion. Ophthalmology. 1978;85(4):394–399.
10. Kraff MC, Sanders DR, Lieberman HL. Specular microscopy in cataract and intraocular lens patients; a report of 564 cases. Arch Ophthalmol . 1980;98(10):1782–1784.
11. Jeganathan VS, Wang JJ & Wong TY. Ocular associations of diabetes other than diabetic retinopathy. Diabetes Care. 2008;31(9):1905–1912.
12. Stanga PE, Boyd SR, Hamilton AM. Ocular manifestations of diabetes mellitus. Curr Opin Ophthalmol. 1999;10(6): 483–489.
13. Itoi M, Nakamura T, Mizobe K, Kodama Y, Nakagawa N, Itoi M. Specular microscopic studies of the corneal endothelia of Japanese diabetics. Cornea. 1989;8(1):2-6.
14. Roszkowska AM, Tringali CG, Colosi P, Squeri CA, Ferreri G. Corneal endothelium evaluation in type I and type II diabetes mellitus. Ophthalmologica. 1999;213(4):258-261.
15. Inoue K, Kato S, Inoue Y, Amano S, Oshika T. The corneal endothelium and thickness in type II diabetes mellitus. Jpn J Ophthalmol. 2002;46(1):65-69.
16. Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB ,Thulesen J. Corneal endothelial cell changes associated with cataract surgery in patients with type II diabetes mellitus. Cornea. 2011;30(7): 749–753.
17. Storr-Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol. 2014; 92(2): 158–160. doi: 10.1111/aos.12064.
18. Su DH, Wong TY, Wong WL, et al. Diabetes, hyperglycemia, and central corneal thickness: the Singapore Malay Eye Study. Ophthalmology. 2008;115(6): 964–968.
19. Lee JS, Lee JE, Choi HY, et al. Corneal endothelial cell change after phacoemulsification relative to the severity of diabetic retinopathy.J Cataract Refract Surg. 2005; 31(4):742–749.
21. Saini JS, Mittal S. In vivo assessment of corneal endothelial function in diabetes mellitus. Arch Ophthalmol. 1996;114(6):649–653.
How to Cite
1.
Dr N. G. Raut, Dr Ravi Chauhan, Dr Sandesh Sonarkhan. CORNEAL ENDOTHELIAL CELL LOSS AFTER SMALL INCISION CATARACT SURGERY IN DIABETIC VERSES NON DIABETIC PATIENTS. Med. res. chronicles [Internet]. 1 [cited 2024May3];3(1):146-55. Available from: https://medrech.com/index.php/medrech/article/view/156
Issue
Vol. 3 No. 1 (2016): Jan-Feb
Section
Original Research Article

Most read articles by the same author(s)