Abstract
Abstract: :
Purpose: Measurement of quality of life (QOL) using an index of functional impairment of vision–dependent activities (VF–14) before and after phacoemulsification surgery (P) in diabetics. Methods: The VF–14 measured QOL in diabetics 42 days before (preop) and 52 days after (postop) P. 30 eyes of 24 diabetic subjects were enrolled and had P with topical anesthesia, acrylic IOLs injected and aggressive treatment of posop inflammation. At preop and postop, best–corrected visual acuity (VA) (logMAR) and retinal thickness (RT) in microns by optical coherence tomography (OCT) were measured. Concentric zones of RT were evaluated: 1 mm (RT1), 3 mm (RT2), and 6 mm (RT3) diameters. Preop diabetic retinopathy (DR) was graded as none, mild–moderate non–proliferative (MNPDR), severe nonproliferative (SNPDR), very severe nonproliferative–early proliferative (PDR), high–risk proliferative (HPDR), status post panretinal photocoagulation (PRP), or poor image (PI). Wilcoxon signed rank tests compared the surgical (S) and non–surgical (NS) eyes and changes in VF–14, VA, and RT. Spearman correlations determined relationships amongst these measurements. Results: VF–14 score improved (p = 0.00114) from preop (mean 75.4 ) to postop (mean 84.9). In S, VA improved (p = 0.0002) from preop (mean 0.61) to postop (mean 0.29). For RT1, RT2, and RT3, the preop means were 221, 267, and 236, respectively. For RT1, RT2, and RT3, there were increases in RT means: 37 (p < 0.0001), 30 (p < 0.0001), and 21 (p = 0.0004), respectively. There were no significant correlations between changes in VF–14, VA, and RT. Preop distribution of DR in S was none (7), NPDR (10), SNPDR (5), PDR (1), HPDR (1), PRP (4), and PI (2) . Severity of DR was not correlated with RT measurements. For NS, there were no changes in RT and VA. Conclusions: Macular edema is thought to be the major cause for decreased VA after P in diabetics. Despite a postop increase in RT, modern P improved the VA and QOL of diabetics. QOL improvement was not related to change in VA. Past thinking was to delay cataract surgery in diabetics, especially those with retinopathy and macular edema. Although this is a short–term study, our findings suggest that the QOL benefit of modern P in diabetics outweighs potential risks, including worsening of DR and macular edema, and cataract surgery–related complications. Increased RT measured with OCT after P suggests that, postoperatively, diabetics be monitored closely for early detection and treatment of macular edema.
Keywords: quality of life • diabetes • cataract