Cataract Surgery in Patients With Diabetes Mellitus
Patients with diabetes mellitus who undergo cataract surgery usually have excellent visual outcomes postoperatively. However, various studies suggest that both eyes with diabetic retinopathy and DME may worsen in severity after cataract surgery. In DRCR.net Protocol P, patients with NPDR but no history of DME were found to have a substantial risk of postoperative DME after cataract surgery. In Protocol Q, which enrolled patients with preexisting DME, only a small percentage of eyes had substantial visual acuity loss or definitive progression in central retinal thickening. Therefore, in clinical practice, it is common for patients with center-involved DME who are about to undergo cataract surgery to receive an anti-VEGF drug injection preoperatively or steroid injection perioperatively. In addition, control of systemic factors should be optimized as much as possible prior to surgery.
Patients with severe NPDR or PDR should be considered for scatter photocoagulation before undergoing cataract removal, if the ocular media are sufficiently clear to allow for treatment. If the density of the cataract precludes adequate evaluation of the retina or treatment, prompt postoperative retinal evaluation and treatment are recommended. In general, all patients with preexisting diabetic retinopathy should be reevaluated after cataract surgery.
Cataract surgeons should be mindful of the need for future regular retinal evaluations and the possibility of future surgical interventions. They should perform an adequate capsulorrhexis to avoid anterior capsular phimosis, and avoid the use of silicone lenses in diabetic eyes, because those lenses may fog with condensation during subsequent vitrectomies. BCSC Section 11, Lens and Cataract, briefly discusses the considerations the cataract surgeon must take into account in patients with diabetes mellitus.
Baker CW, Almukhtar T, Bressler NM, et al.; Diabetic Retinopathy Clinical Research Network Authors/Writing Committee. Macular edema after cataract surgery in eyes without preoperative central-involved diabetic macular edema. JAMA Ophthalmol. 2013;131(7): 870–879.
Bressler SB, Baker CW, Almukhtar T, et al; Diabetic Retinopathy Clinical Research Network Authors/Writing Committee. Pilot study of individuals with diabetic macular edema undergoing cataract surgery. JAMA Ophthalmol. 2014;132(2):224–226.
Table 5-3 Diabetic Retinopathy Clinical Research Network (DRCR.net) Studies
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.