Abstract
Purpose :
Existing studies on cataract surgery in diabetic patients have either looked at all types of diabetes combined or type 2 diabetes alone. This study aims to report the intraoperative and postoperative outcomes of cataract surgery in patients with type 1 diabetes (T1DM) compared to type 2 diabetes (T2DM). We hypothesize that T1DM eyes have greater prevalence of preexisting diabetic retinopathy, worse postoperative visual outcomes, and higher rates of postoperative cystoid macular edema (CME).
Methods :
A retrospective chart review was performed for 8117 patients who underwent cataract surgery at the Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus from January 2014 to January 2020. Demographic data, ocular history, intraoperative and postoperative outcomes were compared using general logistic regression modeling with estimating equations to account for patients who had two eyes included. SAS version 9.4 software was used for the analyses.
Results :
Our patient population was divided into T1DM (n=146), T2DM (n=1849), and patients without diabetes (n=6122). Patients with T1DM were diagnosed with diabetes at a mean age of 23.5 years and underwent cataract surgery after a mean of 29.9 years from diagnosis. Compared to T2DM eyes (n=3115), T1DM eyes (n=233) were more likely to have a history of proliferative retinopathy (63.1% vs 42.4%, p<0.0001), retinal detachment (9.0% vs 2.9%, p<0.0001), and were more likely to have undergone prior vitrectomy surgery (12.9% vs 4.0%, p<0.0001). T1DM eyes had worse postoperative best-corrected visual acuity (BCVA) (logMAR 0.27 vs 0.15, p=0.0003) despite having similar preoperative BCVA to T2DM eyes (logMAR 0.52 vs. 0.44, p=0.092). T1DM eyes had higher rates of posterior capsule opacification (PCO) requiring YAG capsulotomy compared to T2DM eyes (18.9% vs 9.0%, p<0.0001). The rate of postoperative CME was higher in T1DM compared to T2DM eyes but the difference did not reach statistical significance (5.2% vs 2.7%, p=0.105).
Conclusions :
T1DM eyes have greater prevalence of preoperative diabetic retinopathy and have worse BCVA after cataract surgery compared to T2DM eyes. While there was more postoperative CME development in T1DM compared to T2DM eyes, this difference did not reach statistical significance. Additionally, there were higher rates of PCO requiring YAG capsulotomy in T1DM compared to T2DM eyes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.