June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Glycated hemoglobin levels and risk of clinically significant macular edema after cataract surgery in veterans: results from the Veterans Affairs (VA) Ophthalmic Surgery Outcomes Data (OSOD) Project
Author Affiliations & Notes
  • Michael M Lin
    Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Abhishek R Payal
    Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, United States
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Donna Siracuse-Lee
    Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, United States
    Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, United States
  • Tulay Cakiner-Egilmez
    Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, United States
  • Amy Chomsky
    Veterans Affairs Tennessee Valley Healthcare System Center, Nashville, Tennessee, United States
    Vanderbilt Eye Insitute, Vanderbilt University Medical School, Nashville, Tennessee, United States
  • David Vollman
    Ophthalmology Department, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri, United States
    Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States
  • Elizabeth Baze
    Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States
    Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, United States
  • Mary Gilbert Lawrence
    Department of Defense/Veterans Affairs Vision Center of Excellence, Bethesda, Maryland, United States
  • Mary K Daly
    Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, United States
    Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Michael Lin, None; Abhishek Payal, None; Donna Siracuse-Lee, None; Tulay Cakiner-Egilmez, None; Amy Chomsky, None; David Vollman, None; Elizabeth Baze, None; Mary Lawrence, None; Mary Daly, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 789. doi:
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      Michael M Lin, Abhishek R Payal, Donna Siracuse-Lee, Tulay Cakiner-Egilmez, Amy Chomsky, David Vollman, Elizabeth Baze, Mary Gilbert Lawrence, Mary K Daly; Glycated hemoglobin levels and risk of clinically significant macular edema after cataract surgery in veterans: results from the Veterans Affairs (VA) Ophthalmic Surgery Outcomes Data (OSOD) Project. Invest. Ophthalmol. Vis. Sci. 2017;58(8):789.

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

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Abstract

Purpose : Risk of clinically significant macular edema (CSME, thickening of macular area) at various glycated hemoglobin (HgbA1c) levels is an important yet underreported aspect of cataract surgery and its management. We explored the association of elevated HgbA1c levels and risk of diabetic CSME after cataract surgery in veterans.

Methods : Retrospective analysis of a de-identified database of 4923 cataract surgery cases in the VA OSOD Project. We included cases which had data on HgbA1c and occurrence of postoperative diabetic CSME. Logistic regression modeling was used to calculate odds ratios (OR) for risk of CSME at increasing intervals in diabetic range. Odds ratio for CSME in those with HgbA1c ≥ 6.5% compared to <6.5% were calculated after adjusting for age, operating time, history of diabetes, hypertension, history of smoking, and perioperative complications.

Results : Of 4923 cases, 2003 had HgbA1c data available. Mean HgbA1c level was 7.34% (range 4.4%-17.5%, SD 1.6, median 7%). HgbA1c levels ≥ 7.0 were all statistically significantly associated with increased OR for development of CSME, and magnitude of OR for development of CSME increased with increasing HgbA1c levels: for HgbA1c 6.5-6.9 (n=364) [OR 0.6, 95%CI 0.03-5.2, p=0.66]; HgbA1c 7-7.9 (n=543) [OR 5.5, 95%CI 1.73-24.53, p=0.003]; HgbA1c 8-8.9 (n=239) [OR 6.8, 95%CI 1.78-33.94, p=0.005]; HgbA1c 9-9.9 (n=126) [OR 6.8, 95%CI 1.21-44.67, p=0.03]; and HgbA1c ≥ 10 (n=127) [OR 21.3, 95% CI 5.29-126.12, p<0.0001].
Adjusted OR for CSME in those with HgbA1c ≥ 6.5% compared to <6.5% was 4.75 (95% CI 1.57-21.06, p=0.004), adjusted for age, operating time, history of diabetes, hypertension, history of smoking, and perioperative complications.
Of 47 CSME cases in our cohort, 2 (4.3%) cases of CSME were seen at normal HgbA1c levels (4.4%-5.7%), 1 (2.1%) was seen at prediabetes level (5.7%-6.4%), and 44 (93.6%) had HgbA1c levels in diabetic range (≥6.5%).
Of the 47 cases of CSME, 3 (6.4%) had posterior capsular rupture during the procedure. There was no significant difference in occurrence of CSME among veterans who suffered a posterior capsular tear and those who did not (p=0.47).

Conclusions : Risk of diagnosis of CSME after cataract surgery increases significantly with increase in preoperative HgbA1c levels.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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