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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)
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.
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.
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).
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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