Salavat Mădălina-Casiana, Munteanu Mihnea, Chercotă Vlad, Ardelean Adina Iuliana, Schuldez Amanda, Dinu Valentin, Borugă Ovidiu
Department IX Surgery, Discipline of Ophthalmology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania.
Department VII Neurosciences, Neurology II Clinic, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania.
Biomedicines. 2025 Jul 15;13(7):1726. doi: 10.3390/biomedicines13071726.
Cataract surgery, while commonly considered a routine, highly effective, and generally low-risk ophthalmic procedure, has been associated with corneal endothelial cell loss (ECL), a phenomenon particularly pronounced in patients with type 2 diabetes mellitus (DM2). This increased susceptibility in diabetic patients is often attributed to pre-existing corneal abnormalities, including compromised structural integrity and reduced endothelial cell density. Additionally, metabolic stress factors inherent to diabetes, such as chronic hyperglycemia and associated oxidative stress, further exacerbate endothelial vulnerability. Consequently, diabetic patients may experience significantly greater endothelial cell loss during and after cataract surgery, necessitating targeted surgical strategies and careful perioperative management to preserve corneal health and visual outcomes. This paper aims to conduct an extensive and detailed review of the existing scientific literature to thoroughly investigate the relationship between ECL and cataract surgery in patients diagnosed with DM2. This study conducts a critical evaluation to elucidate the mechanisms contributing to high endothelial vulnerability in individuals with diabetes. It systematically compares the rates of ECL observed in diabetic and non-diabetic populations undergoing cataract surgery, examines molecular alterations following the procedure in patients with and without DM2, identifies key risk factors influencing surgical outcomes, evaluates the impact of various surgical techniques, discusses preventative measures, and examines the long-term consequences of ECL in this specific population. Furthermore, this review analyzes the existing research to identify gaps in knowledge and suggest potential directions for future investigations.
白内障手术通常被认为是一种常规、高效且总体风险较低的眼科手术，但它与角膜内皮细胞丢失（ECL）有关，这种现象在2型糖尿病（DM2）患者中尤为明显。糖尿病患者的这种易感性增加通常归因于先前存在的角膜异常，包括结构完整性受损和内皮细胞密度降低。此外，糖尿病固有的代谢应激因素，如慢性高血糖和相关的氧化应激，会进一步加剧内皮细胞的脆弱性。因此，糖尿病患者在白内障手术期间和术后可能会经历明显更多的内皮细胞丢失，这就需要有针对性的手术策略和仔细的围手术期管理，以维护角膜健康和视觉效果。本文旨在对现有科学文献进行广泛而详细的综述，以全面研究被诊断为DM2的患者中ECL与白内障手术之间的关系。本研究进行了批判性评估，以阐明导致糖尿病患者内皮细胞高度脆弱的机制。它系统地比较了接受白内障手术的糖尿病和非糖尿病人群中观察到的ECL发生率，检查了有和没有DM2的患者手术后的分子变化，确定了影响手术结果的关键风险因素，评估了各种手术技术的影响，讨论了预防措施，并研究了ECL在这一特定人群中的长期后果。此外，本综述分析了现有研究，以找出知识空白，并为未来的研究提出潜在方向。
