title: Corneal microstructural changes in nerve fiber, endothelial and epithelial density after cataract surgery in patients with diabetes mellitus.
abstract: OBJECTIVE
  The aim of this study was to analyze microstructural corneal changes following phacoemulsification of cataract with intraocular lens insertion in diabetes mellitus (DM).
  
  
  METHODS
  Prospective study of consecutive patients undergoing phacoemulsification with intraocular lens insertion, over a period of 6 months. Age, gender, serum glycosylated hemoglobin A1c levels, and effective phacoemulsification time were recorded. Anterior segment optical coherence tomography and corneal in vivo confocal microscopy were performed preoperatively and 1-month postoperatively. Subbasal nerve plexus (SBN) density, basal epithelial cell density, and endothelial cell density (ECD) were quantitatively analyzed.
  
  
  RESULTS
  Twenty-eight patients with type 2 DM (71.2 ± 7.6 years) and 23 healthy controls (mean age, 74.4 ± 7.4 years) were recruited. Mean hemoglobin A1c level was 7.5% in patients with DM and 5.7% in the control group (P < 0.0001). A significant reduction in SBN density was noted postoperatively in both DM (P < 0.0001) and non-DM groups (P < 0.0001). Patients with DM had a lower mean SBN density compared with non-DM group, before (P < 0.0001) and after surgery (P < 0.0001). Longer effective phacoemulsification time correlated with a greater decrease in ECD postoperatively in the whole cohort (P < 0.0001), and in the control (P = 0.002) and DM (P = 0.039) groups independently. There was no significant difference in preoperative ECD between the DM group (2254 +/- 426 cells/mm(2)) and non-DM group (2384 +/- 438 cells/mm(2); P = 0.2). [corrected].
  
  
  CONCLUSIONS
  Subbasal nerve density is reduced after cataract surgery in patients with and without DM. However, lower initial SBN density in patients with DM may predispose them to develop diabetic keratopathy. DM does not predispose to greater endothelial loss following phacoemulsification.
authors.affiliation: Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Stuti L
authors.initials: SL
authors.lastname: Misra
authors.forename: Yi Wei
authors.initials: YW
authors.lastname: Goh
authors.forename: Dipika V
authors.initials: DV
authors.lastname: Patel
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Riley
authors.forename: Charles N J
authors.initials: CN
authors.lastname: McGhee
mesh_terms: D000368:Aged; D002452:Cell Count; D003315:Cornea / Q000294:innervation*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004728:Endothelium, Corneal / Q000473:pathology*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D018613:Microscopy, Confocal; D009412:Nerve Fibers; D009882:Ophthalmic Nerve / Q000473:pathology*; D018918:Phacoemulsification; D011446:Prospective Studies; D041623:Tomography, Optical Coherence
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human