Study Finds Greater Endothelial Vulnerability to Phacoemulsification in Diabetes Patients

Cataract surgery can cause significant changes in corneal endothelial cells, thickness and anterior chamber depth, with diabetic patients showing the most pronounced effects. Photo: Wikicommons/Augen33. Click image to enlarge. A new hospital-based observational study from Al-Neelain University Eye Hospital in Sudan suggests that while phacoemulsification induces measurable shifts in corneal and anterior segment parameters in all patients, those with diabetes may experience more pronounced postoperative changes, particularly in endothelial cell metrics.Researchers followed 180 cataract patients (one eye per patient) undergoing routine phaco. Ninety-seven patients (53.9%) were non-diabetic and 83 (46.1%) were diabetic, with mean ages of 61.7 and 61.4 years, respectively.Participants met strict inclusion criteria, including normal central corneal thickness (CCT; 500-600µm), IOP between 10mm Hg and 21mm Hg, anterior chamber depth) >2mm, endothelial cell density (ECD) ≥1000 cells/mm², no active ocular pathology and no refractive surgery or contact lens use. In this analysis, preoperative measurements, including endothelial cell parameters, CCT, anterior chamber depth and IOP, were compared with data collected six weeks after surgery.Data showed endothelial and anterior segment changes in both groups, with consistently larger shifts in diabetic patients. Endothelial cell density declined significantly, dropping by 17% in non-diabetic eyes and by 41% in diabetic eyes. Correspondingly, average endothelial cell size increased by 44% and 57%, respectively. Central corneal thickness increased in all patients—from roughly 483µm preoperatively to 512µm postoperatively—while anterior chamber depth deepened predictably after lens removal, rising from about 2.7mm to 2.8mm to just over 3.1mm in each group. Both diabetic and non-diabetic eyes showed postoperative reductions in IOP as well.These findings offer insight into how phaco affects corneal endothelial cells, anterior chamber depth and IOP in both diabetic and non-diabetic Sudanese adults. The more pronounced alterations seen in diabetic patients underscore the broader impact of the condition on ocular health.“Our study revealed statistically significant changes in ECD post-surgery in both normal and diabetic patients, with greater reductions observed in the diabetic group. This could be attributed to the increased susceptibility of the endothelium to trauma in these patients,” the study authors wrote in The Open Ophthalmology Journal, while emphasizing that these results can help clinicians better understand postoperative changes and educate patients on the importance of diabetes control, early detection and management to minimize complications.“Furthermore,” they concluded, this study may also be useful to eyecare providers practicing where access to eye care is limited and diabetes is prevalent (as in Sudan) “by providing insights into the interventions for surgical planning and follow-up.”Click here for the journal source. Muhjoub N, Gammoh Y, Abdalla B. Changes in Corneal Characteristics, Anterior Chamber Depth, and Ocular Pressure after Phacoemulsification among Diabetic and Non-diabetic Adults. The Open Ophthalmology Journal. 2025. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.