After evaluating the morphological features of corneal endothelial cells and their relationship with the stage of diabetic retinopathy (DR), researchers now suggest clinicians take additional precautions to reduce the risk of endothelial decompensation prior to intraocular surgery, especially in patients with proliferative DR.

This prospective, cross-sectional study analyzed 120 patients with type 2 diabetes and 112 age-matched controls. Patients with diabetes were divided into three groups: no retinopathy, non-proliferative DR and proliferative DR. Endothelial cell density, average cell area, coefficient variation of cell area and percentage of hexagonal cells were evaluated, as was central corneal thickness (CCT).

The team of investigators found that the patients with diabetes had lower endothelial cell density and hexagonal cell rates, while their CCTs were higher. They did not observe significant differences between the two groups in terms of average cell area and coefficient variation of cell area. They did, however, detect significant differences between the endothelial cell density values of each subgroup, with endothelial cell density decreasing as the stage of DR increased. Additionally, hexagonality values differed between subgroups, with the lowest ratio of hexagonal cells in the proliferative DR group. They added that the average cell area, coefficient variation of cell area and CCT measurements were similar across subgroups.

Durukan I. Corneal endothelial changes in type 2 diabetes mellitus relative to diabetic retinopathy. Clin Exp Optom. October 16, 2019. [Epub ahead of print].