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It is well known that several parameters, including nucleus density, axial length, and ultrasound power, have been reported to influence endothelial cell loss after phacoemulsification. It is possible that these factors distorted our consideration. The grade of nucleus density is a major factor among them, as Dr Tsai pointed out. We had already investigated whether nucleus density was significantly different between the diabetic and nondiabetic groups in our study, although we did not show the data. We classified nucleus density into 6 grades according to the Lens Opacities Classification System III1 and compared the number of eyes in each grade between the diabetic and nondiabetic groups using the Mann-Whitney test (Figure). As a result, the number of eyes in each grade by Lens Opacities Classification System III was not significantly different in both groups (P = .80). The distribution of grade in nucleus density was similar in both groups. From this result, we think that nucleus density did not have any influence on our conclusion in this study.
Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Risk Factors for Corneal Endothelial Injury During Small-Incision Cataract Surgery in Patients With Diabetes Mellitis—Reply. Arch Ophthalmol. 2005;123(7):1021. doi:10.1001/archopht.123.7.1021-a