Phaco surgery exacerbates development and progression of diabetic retinopathy

This large cohort study included patients age 65 and older with diabetes who had phacoemulsification cataract surgery at a single center. They found nearly a doubling of the progression rates for diabetic retinopathy 12 months after surgery. However this increased progression rate (32 percent) was lower than previously reported progression rates using intracapsular and extracapsular surgical techniques. A paired comparison of operated and nonoperated eyes of the same patients also suggested a higher progression rate of diabetic retinopathy in operated eyes, although this difference was marginally nonsignificant.

The main thing this article underscores is the need for thorough treatment of active retinopathy prior to cataract surgery where possible, which is widely known and practiced. But even more importantly, it demonstrates the essential need for close follow up in the postoperative period to detect new disease or progression. Particularly in the setting of co-management this fact needs to be widely disseminated to non-ophthalmologists as well as within our own community.