Corneal Endothelial cell changes in diabetic patients after small incision Cataract Surgery

Abstract

Background: Diabetes mellitus is known to cause structural and functional alterations in the corneal endothelium, which may increase susceptibility to surgical trauma during cataract extraction. Small incision cataract surgery (SICS) is widely performed in developing countries; however, data on corneal endothelial changes following SICS in diabetic patients remain limited.

Aim: To evaluate changes in corneal endothelial cell density and morphology in diabetic patients following small incision cataract surgery.

Materials and Methods: This prospective observational study was conducted at Patna Medical College from 1 September 2024 to 1 September 2025. A total of 68 diabetic patients with senile cataract undergoing uneventful SICS were included. Preoperative and one-month postoperative corneal endothelial parameters, including endothelial cell density, coefficient of variation, and percentage of hexagonal cells, were assessed using specular microscopy. Statistical analysis was performed to compare preoperative and postoperative findings.

Results: The mean preoperative endothelial cell density was 2468 ± 218 cells/mm², which decreased significantly to 2216 ± 205 cells/mm² at one month postoperatively (p < 0.001). A significant increase in coefficient of variation and a reduction in hexagonality were observed postoperatively, indicating increased polymegathism and pleomorphism (p < 0.001). Greater endothelial cell loss was noted in patients with longer duration of diabetes. Transient corneal edema was observed in a small proportion of patients and resolved with routine management.

Conclusion: Small incision cataract surgery in diabetic patients is associated with significant endothelial cell loss and morphological changes, particularly in those with longer duration of diabetes. Careful preoperative assessment and meticulous surgical technique are essential to minimize corneal endothelial damage in this high-risk group.

Keywords: Diabetes mellitus; Corneal endothelium; Small incision cataract surgery; Endothelial cell density; Specular microscopy