• 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.