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C. S. Fong, P. Mitchell, E. Rochtchina, T. de Loryn, J. J. Wang, Cataract Surgery and Age-Related Macular Degeneration Study; Diabetes and Visual Outcome After Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4426.
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To assess the influence of diabetes status, its duration, or presence of diabetic retinopathy (DR) on visual outcomes after cataract surgery.
The Cataract Surgery and Age-Related Macular Degeneration Study followed 1994 patients aged ≥65 years who underwent cataract surgery in Sydney, Australia. 1361 of 1562 patients examined 12 months after surgery had complete data for analysis (68% of those recruited). At each visit, best-corrected visual acuity (BCVA) was assessed on a LogMAR chart and mydriatic retinal photography was performed. We compared the pre- and post-operative BCVA of study eyes (eyes that had cataract surgery) by the presence of diabetes and its duration or pre-operative DR.
After excluding 153 'study eyes' of patients with glaucoma and late age-related macular degeneration, 1208 remained for inclusion. Of these patients, 883 had no diabetes and 325 had diabetes (mainly type 2). 134/325 (41.2%) had DR, including 44 (13.5%) who reported previous laser treatment. The post-operative BCVA (in mean letters read correctly) 12 months after surgery improved from 37 to 48 letters in patients without diabetes, from 38 to 48 letters in patients with diabetes but no DR, from 38 to 48 letters in patients with DR and no laser treatment, but only from 31 to 37 letters in patients with DR who had previous laser treatment, after adjusting for age, gender and diabetes duration. The mean BCVA change was less in eyes previously treated with laser (6 letter improvement) compared to an approximate 10-letter improvement in the other 3 groups (all p values <0.04). Diabetes duration ≥20 years was associated with a slightly lower improvement (36 to 43 mean letters; 7-letter gain), than diabetes duration <10 years (36 to 45 letters; 9-letter gain), p=0.4, after adjusting for age, gender and baseline presence of DR.
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