• Cataract/Anterior Segment, Comprehensive Ophthalmology, Retina/Vitreous

    This study evaluates the outcomes of uneventful cataract surgery in diabetic patients without retinal complications.

    Study design

    This post-hoc treatment analysis included data from 2 double-masked randomized clinical trials (RCTs).

    Outcomes

    The analysis reveals that diabetes itself, without posterior segment complications and with an optimal glycemic target, does not impair the outcomes of uneventful cataract surgery. Remarkably, macular swelling was less pronounced among diabetic patients than among nondiabetic patients on steroid monotherapy. The authors attribute this to the prevalent use of cardiovascular medications among patients with diabetes. They point out that administration of preoperative statins decreased levels of permeability and profibrotic factors in the vitreous, and improved vitreoretinal surgery outcomes. Systemic vasoactive medications also improved recovery after cataract surgery.

    Less surprisingly, the combination of steroids and NSAIDs seems more effective than steroid monotherapy at reducing the macular edema induced by cataract surgery in patients with diabetic retinopathy.

    Limitations

    Due to the relatively small sample size, caution is needed in drawing conclusions. Furthermore, late follow-up studies could provide additional information about macular edema kinetics in patients with diabetes and nondiabetic controls.  

    Clinical significance

    This article raises the question of whether statins and other cardiovascular medications might improve recovery after cataract and vitreoretinal surgery, conceivably in people with diabetes as well as certain other patients without the condition. Clearly, further studies are needed. This article also emphasizes the need for combined NSAID/steroid therapy after cataract surgery, rather than steroid monotherapy.