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G.K. Escaravage, K.L. Cohen, M.E. Hartnett, S.B. Patel, B.B. Armstrong, C.M. Janowski; Diabetic Retinopathy, Visual Acuity, and Quality of Life after Phacoemulsification in Patients with Diabetes Mellitus . Invest. Ophthalmol. Vis. Sci. 2004;45(13):303.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Measure changes in diabetic retinopathy (DR), macular edema (ME), best corrected visual acuity (VA), and quality of life (QOL) after phacoemulsification (P). Methods: Using topical anesthesia, 30 eyes (24 subjects) had small incision P and acrylic IOLs (AMO, AR40e) injected. Postop treatment was a topical corticosteroid/antibiotic for 1 week, then a topical corticosteroid and topical NSAID for 5 weeks. VA (logMAR), DR and ME (ETDRS), and QOL (VF–14) were measured 42 days before P and 52 days after. DR was graded as none (0), mild–moderate nonproliferative (MNPDR), severe nonproliferative (SNPDR), very severe nonproliferative or early proliferative (PDR), high risk proliferative (HRPDR), post panretinal photocoagulation (PRP), or poor image (PI). ME was graded as none (0), mild (1), clinically significant ME (2), or PI. Wilcoxon signed rank tests compared surgical (S) and nonsurgical (NS) eyes as well as preop to postop changes in VA, DR, ME, and QOL. Spearman correlations determined relationships among these measurements. Results: For preop S and NS, #s in DR categories were (respectively): 0 (7, 10), MNPDR (10, 8), SNPDR (5, 5), PDR (1, 2), HRPDR (1, 0), PRP (4, 5), & PI (2, 0); #s in ME categories were: 0 (21, 19), 1 (3, 2), 2 (4, 9), & PI (2, 0). For postop S and NS, DR #s were (respectively): 0 (8, 9), MNPDR (6, 9), SNPDR (6, 5), PDR (4, 2), HRPDR (1, 1), PRP (3, 4), & PI (2, 0); ME #s were: 0 (20, 21), 1 (4, 3), 2 (5, 6), & PI (1, 0). For S, VA improved from a mean of 0.61 preop to 0.29 postop (p = 0.0002). The mean preop and postop values for DR and ME in S were not different [DR (2.46 to 2.54) and ME (0.46 to 0.48)]. For NS, the mean preop and postop values for VA (0.26 to 0.17), DR (2.47 to 2.43), and ME (0.70 to 0.53) were not different. For DR and ME, there were no differences between S and NS, preop or postop. Preop VA was worse in S than NS (p < 0.0001), though similar at postop. QOL improved after P (preop mean 75.4 to postop mean 84.9, p = 0.00114). For S, the improvements in VA and QOL were not correlated with changes in DR or ME. Conclusions: Cataract surgery is thought to decrease VA in diabetics due to postop ME. Our short–term study did not demonstrate an adverse effect of P. Using small incision P and aggressive treatment of inflammation, VA and QOL improved while DR and ME remained stable. Modern P techniques may allow for successful outcomes in patiets with diabetes without leading to worsening of DR and/or ME. Therefore, P should not be delayed because of DR and/or ME.
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