Corneal endothelial changes in type 2 diabetes mellitus before and after cataract surgery

Purpose The aim of the study was to investigate the differences in corneal endothelium between patients with and those without diabetes before and after phacoemulsification with intraocular lens implantation. Design The study was designed as an interventional prospective comparative investigation. Setting The study was conducted at Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Patients and methods A total of 100 eyes of 99 patients (49 with and 50 without type 2 diabetes) with senile cataract underwent phacoemulsification with foldable intraocular lens implantation. Specular microscopy was performed preoperatively, at 1 week, and at 3 months postoperatively to evaluate endothelial cell density (ECD), endothelial cell size variability [coefficient of variation (CV)], and central corneal thickness (CCT). Data were analyzed using the t-test, the Mann-Whitney U-test, and Pearson′s correlation coefficient. Results Preoperatively, the mean ECD was 2558.20 cells/mm 2 , the mean CV was 39.84%, and the mean CCT was 512.56 μm in diabetic patients. In controls, the mean ECD was 2484.31 cells/mm 2 , mean CV was 41.03%, and mean CCT was 507.20 μm. There were no significant differences between the two groups (P = 0.145, 0.338, and 0.450 respectively). At 3 months postoperatively, the mean endothelial cell loss (ECL) was 8.09%, mean CV increase was 2.38%, and mean CCT increase was 3.00 μm in diabetic patients, whereas in controls the mean ECL was 8.36%, mean CV increase was 1.06%, and mean CCT increase was 1.30 μm. No significant difference was found in ECL between the two groups (P = 0.850), whereas the increases in CV and CCT were significantly more in diabetic patients than in controls (P = 0.001 and 0.031, respectively). Conclusion There was no significant difference in the corneal endothelium preoperatively between diabetic and nondiabetic patients. Although no significant difference was found in ECL following phacoemulsification between the two groups, diabetic patients had a significantly greater increase in CV (polymegathism) and CCT compared with nondiabetic patients

Comparison between effects of Ringer′s and Ringer′s lactate irrigating solutions on corneal endothelium during phacoemulsfication

Purpose The aim of this study was to compare the effect of phacoemulsification on the corneal endothelium using Ringer′s and Ringer′s lactate as the intraocular irrigating solution. Setting Mansoura Ophthalmic Centre, Faculty of Medicine, Mansoura University, Egypt. Design Prospective randomized comparative study. Materials and methods A total of 102 eyes of 102 patients with senile cataract were randomized to have phacoemulsification with foldable intraocular lens implantation performed using Ringer′s (group 1) or Ringer′s lactate (group 2) as the intraocular irrigating solution. Specular microscopy was done preoperatively, 1 week and 3 months postoperatively to evaluate endothelial cell density (ECD), coefficient of variation (CV), and central corneal thickness. Data were analyzed using the t-test, the Mann-Whitney U-test, and the Pearson correlation coefficient. Results Mean ECD was 2532 cells/mm 2 preoperatively, 2345 cells/mm 2 1 week, and 2284 cells/mm 2 3 months postoperatively in group 1, and 2526, 2374, and 2322 cells/mm 2 , respectively, in group 2. There was a statistically significant difference between preoperative ECD and each of 1 week and 3 months postoperative ECD in each group. No significant difference was found between 1-week mean ECD reduction in group 1 (7.35%) and group 2 (6.05%) or between 3-month mean ECD reduction in group 1 (9.69%) and group 2 (8.07%). Conclusion Ringer′s and Ringer′s lactate solutions are associated with minimal changes in corneal ECD, morphology, and function during uncomplicated phacoemulsification with foldable intraocular lens implantation in patients with normal endothelial cell counts. There is no clinically significant difference in endothelial cell preservation and polymegathism and corneal swelling between Ringer′s and Ringer′s lactate solutions

Outcomes of bimanual microincision cataract surgery and 2.2-mm coaxial phacoemulsification

Purpose To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (B-MICS) versus 2.2-mm coaxial phacoemulsification (C-MICS). Patients and methods This prospective, interventional, randomized, comparative clinical study was carried out on 60 cataractous eyes. Thirty patients were managed surgically by C-MICS through a 2.2 mm mean incision and 30 patients were managed surgically by B-MICS through a 1.2–1.4 mm trapezoidal incision. The main outcomes measures were postoperative best-corrected distant visual acuity, postoperative spherical equivalent, higher-order aberrations, corneal thickness, corneal endothelial cell loss (ECL), and complications during and after surgery. Both groups were compared for all variables preoperatively. Results The visual rehabilitation in group B was faster than that in group A (nonsignificant). There were nonstatistically significant differences, in the best-corrected visual acuity, between both groups throughout the postoperative period. The mean ECL was statistically significantly higher in group A (221.2±44.1) compared with group B (167.5±67.9) (P<0.001). The mean central corneal thickness change was significantly greater in group A than group B (P=0.01). The surgically induced astigmatism was statistically significantly improved in B-MICS (group B) than C-MICS (group A) (P=0.001). For the other corneal aberrations, there were nonsignificant differences between the two groups. No differences were found in the complications during surgeries between the two groups of cataract surgery. Conclusion The two techniques are reliable, functional, effective, and yield good visual outcomes and low complication rates. B-MICS with the smallest incision induces less astigmatism (surgically induced astigmatism), less ECL, fewer central corneal thickness changes, and enables earlier visual rehabilitation