METHODS: During January 2017 to December 2019, 312 patients with diabetic cataract underwent elective phacoemulsification cataract extraction combined with intraocular lens(IOL)implantation were enrolled. The patients were divided into corneal edema group(n=62)and non-corneal edema group(n=250)according to corneal edema status within 1wk after surgery. The gender, age, smoking history, drinking history, diabetes history, hypertension history, glaucoma history, corneal dystrophy, chronic uveitis, lens core hardness Emery classification, preoperative anterior chamber depth, intraoperative ultrasound energy and effective ultrasound time, IOL material and implant location, number of corneal endothelium after surgery were compared between the two groups. Stepwise Logistic regression analysis was used to determine the risk factors and a risk scoring system was constructed base on the determined risk factors. The ROC curve was drawn to analyze the predictive value of the risk score model for postoperative corneal edema.

RESULTS: Of the 312 diabetic cataract patients included, 62 cases(19.9%)had postoperative corneal edema. According to stepwise Logistic regression analysis, age >60 years(OR=2.657, 95% CI: 1.135-6.220), duration of diabetes >10 years(OR=6.932, 95% CI: 1.911-25.145), hypertension history(OR=2.783, 95% CI: 1.037-14.510),glaucoma history(OR=3.679, 95% CI: 1.128-11.999), chronic uveitis(OR=2.601, 95% CI: 1.099-6.156), lens nucleus hardness grade IV to V(OR=8.658, 95% CI: 2.595-28.887), preoperative shallow anterior chamber(OR=3.431, 95% CI:1.679-7.011), postoperative corneal endothelial cell count(OR=3.026, 95% CI: 1.137-8.053)were the risk factor for postoperative corneal edema in patients with diabetic cataract. The risk scoring system was constructed according to the above risk factors: age >60 years old, history of hypertension, history of glaucoma, chronic uveitis, corneal endothelial cell number loss≥10%, shallow anterior chamber corresponding to 1 point, duration of diabetes >10 years and lens hardness Ⅳ-V corresponds to 2 points, with a total score of 0-10 points. The risk score model predicts that the area under the ROC curve of postoperative corneal edema in diabetic cataract patients was 0.848(95% CI: 0.772-0.934)at cut-off value of 8.94, and the sensitivity and specificity were 85.3% and 80.2%, respectively.

CONCLUSION: Age>60 years old, course of diabetes >10 years, history of hypertension, history of glaucoma, chronic uveitis, lens nucleus hardness Ⅳ-Ⅴ, preoperative shallow anterior chamber, postoperative corneal endothelial cell loss is the postoperative occurrence of diabetic cataract patients. The risk factors of corneal edema, the risk scoring model constructed based on the above risk factors has good predictive value for postoperative corneal edema.