Diabetes Itself May Not Impair Recovery After Cataract Surgery
By Lynda Seminara
Selected By: Richard K. Parrish II, MD
Journal Highlights
American Journal of Ophthalmology, February 2019
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Although studies suggest that the risk of pseudophakic cystoid macular edema (PCME) after routine cataract surgery is higher for patients with diabetes, this may relate more to diabetic retinopathy than to diabetes alone. In a post-hoc analysis of data from two double-blind randomized controlled trials, Danni et al. compared outcomes of uneventful cataract surgery between nondiabetic patients and those with diabetes but no retinopathy. For nearly all outcomes assessed, there were no substantial differences between the groups.
This study included 276 eyes (266 patients) that underwent routine cataract surgery. Patients with type 1 or 2 diabetes (56 eyes) were compared with nondiabetic patients (220 eyes). Clinical evaluation was performed by the operating physician, and a research technician recorded data attained before surgery and on postoperative day 28. Demographics and baseline ophthalmic and surgical parameters were comparable for the study groups.
The following outcomes were similar for patients without and with diabetes, respectively: increase in aqueous flare (6.3 ± 16.4 vs. 3.7 ± 8.9 photon units/ms; p = .282), increase in central retinal thickness (CRT; 12.0 ± 38.2 vs. 5.9 ± 15.8 μm; p = .256), and improvement in corrected distance visual acuity (0.57 ± 0.31 vs. 0.53 ± 0.35 decimals; p = .259).
In eyes that received steroid monotherapy (n = 64), the increase in CRT was 38.1 ± 72.8 μm for those without diabetes and 7.8 ± 6.6 μm for those with diabetes (p = .010). In eyes of patients on nonsteroidal anti-inflammatory drug (NSAID) monotherapy (n = 157), the increase in CRT was 5.7 ± 18.4 μm for nondiabetic patients and 6.2 ± 20.5 μm for diabetic patients (p = .897). Among the 55 eyes that received steroid and NSAID therapy, CRT increased 3.6 ± 4.1 μm in nondiabetic patients and 2.9 ± 3.2 μm in patients with diabetes (p = .606). Within 28 days of the surgery, PCME was reported for eight eyes; of these, seven were in the nondiabetic group. On day 28, intraocular pressure was nearly identical for the study groups.
The only outcome with a significant between-group difference was the change in CRT among patients on steroid monotherapy. Therefore, patients with optimally managed diabetes may not be at greater risk of PCME. In light of the relatively small sample size, the authors urged caution in drawing conclusions from their study. Longer follow-up may shed light on differences in macular edema kinetics between patients with and without diabetes.
The original article can be found here.