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Jennifer Lindsey, Nakul Shekhawat, Mary Gilbert Lawrence, David Vollman, Mary K Daly, Elizabeth F Baze, Amy Chomsky, Veterans Affairs (VA) Ophthalmic Surgical Outcomes Data Project; 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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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.
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.
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.
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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