Clinical outcomes after phacoemulsification in patients with concurrent pseudoexfoliation syndrome and diabetes mellitus

BACKGROUNDThe phacoemulsification surgery in cataract patients with concurrent pseudoexfoliation (PEX) and diabetes mellitus (DM) poses multiple challenges and increases the incidence of intraoperative and postoperative complications. AIMTo describe corneal endothelial changes, central corneal thickness (CCT), postoperative inflammation, visual outcomes, and exploratory prognostic associations after phacoemulsification in patients with concurrent PEX and DM. METHODSThis prospective, single-centre descriptive case series analyzed 100 eyes of 100 patients with concurrent PEX and DM who completed the required analytic follow-up after phacoemulsification by one surgeon.We assessed endothelial cell density (ECD) and best-corrected visual acuity (BCVA) preoperatively and at 42 days; we assessed CCT preoperatively and at the early postoperative visit recorded in the study dataset.We explored associations using Spearman rank correlation and multivariable logistic regression.The source dataset did not include the screening log, incomplete follow-up records, or a reproducible definition of the dichotomous poor-vision endpoint. RESULTSMean ECD decreased from 2466 ± 394 cells/mm² to 2223 ± 386 cells/mm² at 42 days [mean change, -243 cells/mm²; 95% confidence interval (CI): -270.6 to -215.4].Mean CCT increased from 469.5 ± 30.6 µm to 553.2 ± 58.9 µm at the early postoperative assessment (mean change, 83.7 µm; 95%CI, 74.8-92.6).Mean BCVA improved from 0.646 ± 0.31 to 0.065 ± 0.12 LogMAR at 42 days (mean change, -0.581; 95%CI: -0.636 to -0.526).Cataract 4 / 26 grade, cumulative dissipated energy, and baseline BCVA correlated with absolute visual improvement (all P < 0.001).We excluded analyses using the unreproducible dichotomous poor-vision endpoint. CONCLUSIONIn this descriptive case series of patients with concurrent PEX and DM who completed analytic follow-up, phacoemulsification was followed by favourable short-term visual outcomes despite endothelial cell loss and early corneal thickening.The uncontrolled design and incomplete accounting of the source population preclude causal inference, estimation of additive risk, or generalisation to all enrolled patients.