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Colin J Chu, Charlotte Buscombe, Ahmed A I Sallam, Quresh Mohamed, Robert Johnston; Diabetic retinopathy increases the risk of macular edema following cataract extraction. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6212.
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© ARVO (1962-2015); The Authors (2016-present)
To quantify the incidence of clinically significant macular edema following cataract extraction and the effect of diabetic retinopathy.
The UK Royal College or Ophthalmologists Diabetic Eye Disease and Cataract National Datasets were collected prospectively within an electronic medical record system (Medisoft Ophthalmology) from a single UK centre. All patients were prescribed four weeks of topical steroid and had at least one follow-up appointment an average of five weeks after surgery. Only eyes with the documented absence of pre-operative macular edema were included. Eyes with surgical complications, uveitis, vein occlusion, epiretinal membrane, previous anti-VEGF therapy, intraoperative complications, additional procedures, laser within the previous 90 days or receiving perioperative NSAIDs were excluded. A new diagnosis of macular edema within 90 days of surgery was the primary outcome.
10,027 consecutive phacoemulsification operations performed by 54 different surgeons between August 2010 and August 2014 fulfilled the selection criteria. 995 operations were performed on the eyes of patients with diabetes, of which 8% were type I and 92% type II diabetics. 50.2% of eyes were from males and the mean age in the cohort was 74.6 years at the time of operation. An incidence of post-operative macular edema of 1.42% was determined for non-diabetic eyes. Compared to the eyes of non-diabetics, eyes from patients with diabetes, but without retinopathy had a non-significant relative risk (RR) of 1.13 (95% CI, 0.58-2.21). The RR from mild non-proliferative diabetic retinopathy (NPDR) was 2.91 (95% CI, 1.59-5.32*) whilst that of moderate to severe NPDR was 4.23 (95% CI, 1.91-9.37*). Only 17 eyes with proliferative retinopathy met the inclusion criteria and none developed macular edema. Patients with regressed proliferative retinopathy and PRP scars had a non-significant RR of 1.41 (95% CI, 0.20-9.90). Eyes that had previously received macular laser had a non-significant RR of 2.22 (95% CI, 0.67-7.37) compared to eyes naïve to laser.
This is one of the largest retrospective clinical studies of post-operative macular edema following phacoemulsification surgery. It supports the need for careful management and the routine use of prophylactic treatments including for example, topical NSAIDs, in high-risk patients such as those with diabetic retinopathy.
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