Cataract Surgery and its Complications in Diabetic Patients

Haddad, Nagib; Sun, Jennifer K.; Abujaber, Samer; Schlossman, D.; Silva, Paolo S.

doi:10.3109/08820538.2014.959197

Cited by 80 publications

(57 citation statements)

References 75 publications

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“…Since there is no established mechanism through which diabetic retinopathy contributes to cataract development, it is possible that an association is due to the “common soil” hypothesis in which risk factors for cataract and diabetic retinopathy, including oxidative stress and hyperglycaemia, are shared . Retinopathy is thought to worsen after CS in people with diabetes, but advances in surgical techniques are likely to have substantially attenuated this risk . In addition, low grade retinopathy may be masked by lens opacities and only detected at the time of CS .…”

Section: Discussionmentioning

confidence: 99%

“…51 Retinopathy is thought to worsen after CS in people with diabetes, but advances in surgical techniques are likely to have substantially attenuated this risk. 52,53 In addition, low grade retinopathy may be masked by lens opacities and only detected at the time of CS. 54 In the Kinmen study, diabetic retinopathy and CS were assessed at the same time, 6 to 8 years after baseline.…”

Section: Maresmentioning

confidence: 99%

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A systematic review of risk factors for cataract in type 2 diabetes

Drinkwater

Davis

2018

Diabetes Metabolism Res

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Type 2 diabetes (T2D) is a risk factor for cataract development. With T2D prevalence increasing, the burden of cataract-associated vision loss will also increase. We aimed to characterise cataract diabetes-specific risk factors to assist prevention and management strategies. As part of a systematic review, two investigators independently searched online electronic databases according to a predetermined protocol for relevant published data to end-March 2018. Studies were included if they were longitudinal with ≥100 participants, diabetes was defined, a description of cataract assessment was provided, data were from humans, and the reports were in English. Study quality was assessed using the Newcastle Ottawa Scale and GRADE. Of 5255 publications identified, 19 from 13 study populations were included. The overall risk of bias was low. There was between-study variability. Age and glycaemic control were consistently associated with cataract development in T2D, but blood pressure, diabetes duration, sex, and aspirin use were not. Serum lipids and smoking remain possible risk factors, but available data are inconclusive. Glycaemia is the only consistent modifiable risk factor amongst a range of candidate variables. Due to the lack of consistency of the available evidence, and since mortality associated with T2D is declining with the likelihood of increased cataract-associated vision loss, additional well-conducted longitudinal studies are needed to identify modifiable risk factors that could prevent or delay cataract formation.

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Section: Discussionmentioning

confidence: 99%

Section: Maresmentioning

confidence: 99%

A systematic review of risk factors for cataract in type 2 diabetes

Drinkwater

Davis

2018

Diabetes Metabolism Res

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“…25 Although the development of cataracts and the need for cataract surgery are not specific to diabetes, they are more frequent in patients with diabetes, 26 and surgery for cataracts occurs at a younger age in patients with this condition. 27 In the Wisconsin Epidemiologic Study of Diabetic Retinopathy, 28 elevated glycated hemoglobin levels were associated with an increased risk of cataract surgery among persons with type 1 diabetes. In a case–control study involving patients with type 2 diabetes, 29 elevated glycated hemoglobin levels were associated with the prevalence of posterior subcapsular cataract and in a third study with an increased incidence of lens opacities and cataract progression.…”

Section: Discussionmentioning

confidence: 99%

Intensive Diabetes Therapy and Ocular Surgery in Type 1 Diabetes

2015

N Engl J Med

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BACKGROUND The Diabetes Control and Complications Trial (DCCT) showed a beneficial effect of 6.5 years of intensive glycemic control on retinopathy in patients with type 1 diabetes. METHODS Between 1983 and 1989, a total of 1441 patients with type 1 diabetes in the DCCT were randomly assigned to receive either intensive diabetes therapy or conventional therapy aimed at preventing hyperglycemic symptoms. They were treated and followed until 1993. Subsequently, 1375 of these patients were followed in the observational Epidemiology of Diabetes Interventions and Complications (EDIC) study. The self-reported history of ocular surgical procedures was obtained annually. We evaluated the effect of intensive therapy as compared with conventional therapy on the incidence and cost of ocular surgery during these two studies. RESULTS Over a median follow-up of 23 years, 130 ocular operations were performed in 63 of 711 patients assigned to intensive therapy (8.9%) and 189 ocular operations in 98 of 730 patients assigned to conventional therapy (13.4%) (P<0.001). After adjustment for DCCT baseline factors, intensive therapy was associated with a reduction in the risk of any diabetes-related ocular surgery by 48% (95% confidence interval [CI], 29 to 63; P<0.001) and a reduction in the risk of all such ocular procedures by 37% (95% CI, 12 to 55; P = 0.01). Forty-two patients who received intensive therapy and 61 who received conventional therapy underwent cataract extraction (adjusted risk reduction with intensive therapy, 48%; 95% CI, 23 to 65; P = 0.002); 29 patients who received intensive therapy and 50 who received conventional therapy underwent vitrectomy, retinal-detachment surgery, or both (adjusted risk reduction, 45%; 95% CI, 12 to 66; P = 0.01). The costs of surgery were 32% lower in the intensive-therapy group. The beneficial effects of intensive therapy were fully attenuated after adjustment for mean glycated hemoglobin levels over the entire follow-up. CONCLUSIONS Intensive therapy in patients with type 1 diabetes was associated with a substantial reduction in the long-term risk of ocular surgery. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; DCCT/EDIC ClinicalTrials.gov numbers, NCT00360893 and NCT00360815.)

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“…These modalities, when used appropriately, can maximize visual potential in patients with high risk PDR, CSME, and venous occlusions (23)(24)(25)(26)(27). For those patients with visually significant cataracts affecting visual function and activities of daily living, cataract extraction with intraocular lens placement is a well-established option with generally good outcomes, although patients with diabetes are at higher risk for intraoperative and post-operative complications (18,28).…”

Section: Treatmentmentioning

confidence: 99%