The Open Ophthalmology Journal

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Comparison of Endothelial Cell Density, Morphological Changes and Central Corneal Thickness after Phacoemulsification between Diabetic and Non-Diabetic Patients

Budiman Budiman1, 2, *
1 Cataract and Refractive Surgery Unit, Cicendo National Eye Center Bandung, Bandung, Indonesia
2 Department of Ophthalmology Faculty of Medicine Universitas Padjajaran/National Eye Center - Cicendo Eye Hospital Bandung, Indonesia



Corneal endothelial tissues are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients.


To compare endothelial density, hexagonality, Coefficient of Variance (CV) and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at four weeks after phacoemulsification.


Specular microscopy examinations prior to phacoemulsification and at four-weeks after phacoemulsification were performed on diabetic and non-diabetic groups with cataract. Later, patients in the diabetic group were divided based on their HbA1c level. The changes in endothelial density, the percentage of hexagonality, CV and CCT were evaluated.


At a four-weeks follow up, there were no statistical differences in endothelial cells density, CV and CCT changes between diabetic and non-diabetic groups. Mean (SD) of hexagonality percentage at four weeks of follow-up was lower (p-value=0.001) in diabetic group [(14.6) 41.7%] compared to non-diabetic group [(14.5) 50.1%]. There were no differences in endothelial cells density, hexagonality, CV and CCT values between the diabetic group with HbA1c level <7.5% and HbA1c level ≥7.5% at 4-weeks after phacoemulsification.


There were no statistically significant differences in the endothelial loss, reduction of CV and CCT changes between the diabetic and non-diabetic group at four-weeks follow up after phacoemulsification. Diabetic group showed greater hexagonality decrease compared to non-diabetic group at four weeks after phacoemulsification. Different HbA1c levels did not affect the changes in endothelial density, the percentage of hexagonality, CV and CCT after phacoemulsification.

Keywords: Corneal endothelial cell, Hexagonality, Central corneal thickness, Cataract, Phacoemulsification, Diabetes mellitus.

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 14
First Page: 15
Last Page: 20
Publisher Id: TOOPHTJ-14-15
DOI: 10.2174/1874364102014010015

Article History:

Received Date: 17/12/2019
Revision Received Date: 13/02/2020
Acceptance Date: 06/04/2020
Electronic publication date: 16/05/2020
Collection year: 2020

© 2020 Budiman Budiman.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to the author at the Cataract and Refractive Surgery Unit, Cicendo National Eye Center Bandung, Bandung, Indonesia; E-mail:

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