AIM: To investigate the influence of phacoemulsification on corneal endothelial cells and its injury risk factors in diabetic cataract patients.

METHODS: From January 2013 to October 2015,186 diabetic cataract patients(224 eyes)as diabetes group and 190 patients with simple cataract(227 eyes)as control group in our hospital were enrolled. All patients received phacoemulsification combined with intraocular lens implantation. Observation of corneal endothelial cell density, coefficient of variation and percentage of hexagonal cells preoperatively, 1d, 1wk, 1 and 3mo postoperatively were carried out, and multiple Logistic regression analysis for risk factors of corneal endothelial cell injury was taken.

RESULTS: There were no significant difference in the density of corneal endothelial cells, the coefficient of variation and the percentage of hexagonal cells between the two groups before surgery(P>0.05). Each time point after operation corneal endothelial cell density and the percentage of hexagonal endothelial cells of diabetes group were significantly lower than the preoperative and those of control group(P<0.05). Each time after operation endothelial cell coefficient of variation of diabetes group were significantly higher than the preoperative(P<0.05). The endothelial cell coefficient of variation in diabetes group of the 1wk, 1 and 3mo after operation were significantly higher than those of the control group(P<0.05). Corneal endothelial cell density and percentage of hexagonal cells of the control group at 1wk, 1 and 3mo after operation were significantly lower than the preoperative(P<0.05). The endothelial cell coefficient of variation of control group at 1wk, 1 and 3mo after operation were significantly higher than the preoperative(P<0.05). Single factor analysis showed that age, shallow anterior chamber, long ultrasonic time, short eye axis, high energy ultrasonic, high cumulative released energy, a lot of perfusate and nuclear hardness ≥ grade Ⅲ associated with corneal endothelial cell injury(P<0.05). Multivariate Logistic regression analysis showed that age, long ultrasonic time, high ultrasonic energy, high cumulative released energy and nuclear hardness ≥ grade Ⅲ were the risk factors of corneal endothelial cell injury, the OR value and 95%CI were 1.742(1.056-2.682), 1.958(1.227-3.135), 2.064(1.274-3.256), 2.585(1.493-3.682), 2.193(1.348-3.316).

CONCLUSION: The injury of corneal endothelial cells after phacoemulsification in diabetic cataract patients is more serious than in patients with simple cataract. Age,long ultrasonic time,high ultrasonic energy, high cumulative released energy and nuclear hardness ≥ grade Ⅲ are the risk factors of corneal endothelial cell injury.