الفهرس 
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Abstract
The main limitations of our study could be summarized in 5 main points. The relatively small sample size (n=64 eyes) and the short-term follow-up period (6 follow-up months) were our 2 major limitations. Furthermore, our use of the hydrophilic type of IOL for intraocular implantation and our inability to provide the hydrophobic type of IOL; to guard against the development of postoperative PCO, due to coast-related issues was the third study limitations. In 1addition, our inability to provide the highly purified intraocular viscoelastic injection (e.g. 40mg sodium chondroitin sulfate and 30 mg sodium hyaluronate, VISCOAT, Alcon laboratories inc, Forth Worth, Texas, USA) for extra protection of the corneal endothelium against the hazards of phacoemulsification for coast-related issues was another main limitation of our study. Finally, we acknowledge that we were unable to continue following the two PPME cases in the diabetic group after the end of the study and we actually refereed them to the Vitro-retinal Clinic in the Ophthalmology Department for further assessment and treatment.
Therefore, we recommend further additional future multicenter studies with larger sample sizes and long-term follow-up durations to investigate the prevalence of PPME among the diabetic and non-diabetic populations, document if there are advantageous effects of using hydrophobic IOL and highly purified intraocular viscoelastic injection to lower the incidence of postoperative development of PCO and guard against corneal endothelial cell loss respectively.
Conclusion
In conclusion, the endothelial CD of the specular microscopy is a sensitive parameter that is directly related to the CDE of phacoemulsification and not related to be a diabetic or non-diabetic patient as the non-diabetic group exhibited statistically significant intraoperative endothelial cell loss that was associated with the relatively higher intraoperative CDE when compared to the diabetic group. Our study documented major difference between the diabetic and non-diabetic patients regarding the postoperative specular microscopy changes. In the non-diabetic group, the postoperative remained healthy corneal endothelium exhibited better postoperative healing response to the surgical insult induced by phacoemulsification regarding the endothelial cells’ polymegethism. We recorded statistically significant higher CV and lower minimal cell size changes in comparison to the diabetic group. These outcomes indicated the ability of the healthy corneal endothelium in non-diabetic patients to rapidly and efficiently restore the function of the lost intraoperative endothelial cells by increasing its cells’ polymegethism.
Our outcomes confirmed that there was a similar probability of PPME occurrence in both non-diabetic and diabetic patients as this probability was mostly related to the surgical procedure itself. Meanwhile, the non-diabetic PPME exhibited rapid and complete recovery within one month in comparison to the diabetic PPME that exhibited gradual and incomplete recovery during the postoperative six months follow-up period. Therefore, we think that both groups had no differences regarding PPME development, yet the differences between both groups could be attributed to the good recovery process in short time in the non-diabetic patients. Furthermore, the diabetic patients revealed higher and early incidence of postoperative PCO development in contrast to the non-diabetic patients who had no signs of postoperative PCO till the end of the study.
Finally, we simply believe that the extent of the cell injury, loss and subsequent edema is directly related to the intraoperative surgical insult regardless being a diabetic or non-diabetic patient. However, we also believe that the postoperative ability of the cells to heal, repair and restore its functions depends on the health of these cells that is directly related to being a diabetic or non-diabetic patient.