June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Impact of Diabetes Mellitus on cataract surgery outcomes: results of the Ophthalmic Surgical Outcomes Data Project
Author Affiliations & Notes
  • Jennifer Lindsey
    Vanderbilt Eye Institute, Vanderbilt University Medical, Nashville, TN
    VA Tennessee Valley Healthcare System Center, Nashville, TN
  • Nakul Shekhawat
    Vanderbilt Eye Institute, Vanderbilt University Medical, Nashville, TN
    VA Tennessee Valley Healthcare System Center, Nashville, TN
  • Mary Gilbert Lawrence
    DoD/Vision Center of Excellence, Arlington, VA
  • David Vollman
    Ophthalmology, St. Louis VA Medical Center, St. Louis, MO
    Ophthalmology, Washington University School of Medicine, St. Louis, MO
  • Mary K Daly
    Ophthalmology, VA Boston Healthcare System, Boston, MA
    Ophthalmology, Boston University School of Medicine, Boston, MA
  • Elizabeth F Baze
    Michael E. DeBakey VA Medical Center, Houston, TX
    Cullen Eye Institute, Baylor College of Medicine, Houston, TX
  • Amy Chomsky
    Vanderbilt Eye Institute, Vanderbilt University Medical, Nashville, TN
    VA Tennessee Valley Healthcare System Center, Nashville, TN
  • Footnotes
    Commercial Relationships Jennifer Lindsey, None; Nakul Shekhawat, None; Mary Lawrence, None; David Vollman, ForSightV (C), Vistakon (C); Mary Daly, None; Elizabeth Baze, None; Amy Chomsky, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 674. doi:
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    • Get Citation

      Jennifer Lindsey, Nakul Shekhawat, Mary Gilbert Lawrence, David Vollman, Mary K Daly, Elizabeth F Baze, Amy Chomsky, ; Impact of Diabetes Mellitus on cataract surgery outcomes: results of the Ophthalmic Surgical Outcomes Data Project . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):674.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To determine whether pre-operative comorbidities of Non-Insulin Dependent Diabetes Mellitus (NIDDM) and Insulin Dependent Diabetes Mellitus (IDDM) are associated with increased rates of untoward events during cataract surgery and/or poor visual outcomes.

Methods: Retrospective analysis of an existing databank of 4,923 cataract surgery cases from the Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data Project. The data were analyzed as to the effect of pre-operative diabetic status (non-diabetic, NIDDM, or IDDM), on post-operative best-corrected visual acuity (BCVA), target refraction missed by >0.5 to >1.0 diopter, persistent post-operative corneal edema, inflammation, elevated intraocular pressure (IOP) at one month after surgery, cystoid macular edema (CME), and retinal detachment (RD). P values were calculated using the Chi square test. Multivariable logistic regression, adjusting for age, diabetes status and control (HgBA1C), history of diabetic retinopathy, history of glaucoma, history of uveitis, and presence/absence of complex cataract (defined as mature, traumatic, pseudoexfoliative, or posterior polar cataract), was used to determine odds ratios (OR) and 95% confidence intervals (CI) for complications.

Results: Compared to non-diabetics (N=2,563), IDDM patients (N=835) had higher prevalence of BCVA worse than 20/40 (14.2% vs. 9.6%, p<0.001), BCVA worse than 20/60 (4.4% vs. 2.4%, p<0.01), elevated IOP (1.6% vs. 0.6%, p<0.05), CME (4.2% vs. 1.8%, p<0.001), and RD (0.5% vs. 0.1%, p<0.05). Compared to non-diabetics, IDDM patients had significantly higher odds of CME (OR 1.96, 95% CI 1.16-3.31), elevated IOP (OR 3.0, 95% CI 1.34-6.67), and RD (OR 4.93, 95% CI 1.00-24.20, p<0.05) and marginally significant higher odds of vitrectomy (OR 1.46, 95% CI 0.93-2.27, p=0.097) even after adjusting for pre-operative risk factors. NIDDM patients (N=1,011) did not differ significantly from non-diabetics.

Conclusions: IDDM may put cataract surgery patients at increased risk of cataract surgery complications including increased post-operative IOP, rate of CME, RD and vitrectomy; while NIDDM does not appear to carry the same risks.

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