Patients with diabetic macular edema (DME) who are actively managed with anti-VEGF injections before and after cataract surgery may experience mixed outcomes: While visual acuity (VA) may improve in these patients, their DME may worsen and perhaps require additional treatment, report researchers at the Mayo Clinic in Rochester, Minnesota.1
Real-life outcomes. For this study, the researchers retrospectively reviewed the charts of 30 patients (37 eyes) who underwent cataract surgery from Jan. 1, 2012, to Dec. 31, 2017. All were actively managed with anti-VEGF injections for DME before and after cataract surgery, with at least one injection within the six months preceding surgery. Most eyes (n = 22) received injections of bevacizumab.
Visual acuity. Before surgery, mean VA for all eyes was 20/107. This improved to 20/42 at post-op month 1 and to 20/35 at post-op month 6. However, at the six-month mark, the VA of three eyes was worse than it had been before surgery. In one of these three eyes, macular fluid also worsened following surgery.
Retinal thickness. While 30 eyes (81.1%) had fluid on the preoperative OCT, there were no statistically significant differences in central subfield thickness measurements before and after surgery.
Worsening of DME. “Perhaps the most surprising result was that 46% of eyes developed worse DME following cataract surgery,” said coauthor Sophie J. Bakri, MD. However, nearly all of these eyes did not have worse VA at any postoperative time point than did those eyes without new fluid.
Active management required. Careful patient selection may account for the surgery’s success, the researchers said.
“Our practice is conservative in choosing patients for cataract surgery, especially in those eyes with DME. The cataracts were visually significant, which is likely the reason patients saw a significant improvement in vision,” said lead author Matthew R. Starr, MD.
Dr. Starr added, “If a patient has a very dense cataract and can benefit from cataract surgery, the surgery is certainly warranted. However, patients need to understand they may need further intravitreal anti-VEGF injections and perhaps even more frequent follow-up” after surgery.
Dr. Bakri advised clinicians to actively control the DME preoperatively with intravitreal anti-VEGF injections. “Also, have a plan for postoperative management rather than an as-needed approach.”
1 Starr MR et al. Am J Ophthalmol. Published online April 11, 2021.
Relevant financial disclosures—Drs. Bakri and Starr: None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Cheng Singapore National Medical Research Council: S.
Dr. Jeng EyeGate Pharmaceuticals: O; GlaxoSmithKline: C; Kedrion: C; Merck: C; Sanofi: C; Santen: C.
Dr. Kaiser Aerie: C; Aerpio: C; Allegro: C; Allergan: C; Bayer Healthcare Pharmaceuticals: C,L; Biogen: C; Boehringer Ingelheim: C; Clearside: C; Eyevensys: C; Formycon: C; Galecto: C; Galimedix: C; Genentech: C; Glaukos: C; iRenix: C; Iveric Bio: C,O; jCyte: C; kala: C; Kanghong: C; Kodiak: C; Novartis: C,L; Omeros: C; Opthea: C; Oxurion: C; Regeneron: C,L; RegenxBio: C; Retinal Sciences: C,O; Santen: C; Stealth: C; Verana: O.
Dr. Phylactou None.
||Consultant fee, paid advisory boards, or fees for attending a meeting.
||Employed by a commercial company.
||Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
||Equity ownership/stock options in publicly or privately traded firms, excluding mutual funds.
||Patents and/or royalties for intellectual property.
||Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies.
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