Comparison of Endothelial Cell Density Post-Phacoemulsification Between Diabetic and Non-Diabetic Patients: A Prospective Study at A Tertiary Care Centre in Udaipur

Background: Cataract is the leading cause of reversible blindness worldwide, and phacoemulsification is currently the most widely performed surgical technique for cataract extraction. However, the procedure may cause damage to the corneal endothelium due to ultrasound energy and intraocular manipulation. Diabetes mellitus is known to cause structural and functional alterations in the corneal endothelium, potentially increasing the susceptibility of diabetic patients to endothelial damage during cataract surgery. Evaluating endothelial cell density changes following phacoemulsification in diabetic and non-diabetic patients is therefore important for understanding postoperative corneal outcomes.

Aim: To compare endothelial cell density changes following phacoemulsification between diabetic and non-diabetic patients.

Materials and Methods: This prospective comparative observational study was conducted at the Department of Ophthalmology of a tertiary care centre in Udaipur, Rajasthan, from June 2025 to November 2025. A total of 96 patients with age-related cataract undergoing phacoemulsification with posterior chamber intraocular lens implantation were included. Patients were divided into two groups: 48 diabetic patients and 48 non-diabetic patients. Preoperative and postoperative corneal endothelial parameters were evaluated using specular microscopy, including endothelial cell density, coefficient of variation, and percentage of hexagonal cells. Data were analyzed using SPSS software. Continuous variables were expressed as mean ± standard deviation and compared using independent and paired t-tests, while categorical variables were analyzed using the chi-square test. A p-value of <0.05 was considered statistically significant.

Results: The mean preoperative endothelial cell density was slightly lower in diabetic patients (2384.6 ± 152.3 cells/mm²) compared with non-diabetic patients (2441.2 ± 147.8 cells/mm²), although the difference was not statistically significant (p = 0.07). Postoperatively, endothelial cell density decreased significantly in both groups; however, the reduction was greater in diabetic patients (2145.8 ± 165.4 cells/mm²) than in non-diabetic patients (2268.4 ± 158.9 cells/mm²; p = 0.0003). The mean endothelial cell loss was significantly higher in diabetic patients (238.8 ± 58.6 cells/mm²) compared with non-diabetic patients (172.8 ± 52.4 cells/mm²; p < 0.001). Similarly, the percentage endothelial cell loss was greater in the diabetic group (10.0 ± 2.6%) than in the non-diabetic group (7.1 ± 2.2%; p < 0.001). Morphological endothelial changes, including increased coefficient of variation and decreased hexagonality, were also more pronounced in diabetic patients.

Conclusion: Diabetic patients experience significantly greater endothelial cell loss and morphological changes following phacoemulsification compared with non-diabetic patients. Careful preoperative evaluation and endothelial protective surgical techniques are essential to optimize surgical outcomes in diabetic individuals undergoing cataract surgery