Prevention of macular edema in patients with diabetes after cataract surgery

Laursen, Sophie Bryde; Erichsen, Jesper Høiberg; Holm, Lars; Kessel, Line

doi:10.1016/j.jcrs.2019.04.025

Cited by 31 publications

(39 citation statements)

References 83 publications

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“…Second, the CDE during cataract surgery was low and postoperative inflammatory reaction was mild. Third, patients received nonsteroidal anti-inflammatory eye drops in addition to steroid eye drops, which had been reported to be more effective than steroid only in preventing PCME [21] and might also play a role in influencing the pattern of macular microvascular changes in response to phacoemulsification surgery.…”

Section: Discussionmentioning

confidence: 99%

Transient reduction in macular deep capillary density on optical coherence tomography angiography after phacoemulsification surgery in diabetic patients

Wang

Chen

2020

BMC Ophthalmol

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Background: To evaluate macular microvascular changes and associated factors in diabetic patients following uncomplicated phacoemulsification surgery. Methods: In this prospective observational study, we enrolled diabetic patients and non-diabetic controls who underwent phacoemulsification surgery. Participants were examined at postoperative day 1 (POD1), 10 (POD10), 30 (POD30), and 90 (POD90), using macular 3x3mm OCT angiography scan (RTVue-XR Avanti; Optovue, Inc., Fremont, CA). Integrated automated algorithms were used to quantify parafoveal vessel density (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP). To minimize measurement bias, subjects with corneal edema or capsular opacity at any postoperative visit were excluded. Results: The study included 21 eyes of 21 diabetic patients and 21 eyes of 21 non-diabetic controls. In diabetic patients, no significant change in SCP-VD could be detected (P = 0.57); DCP-VD reduced from 50.24 ± 2.33% at POD1 to 48.33 ± 3.07% at POD30 (P = 0.019), and restored to 50.74 ± 3.44% at POD90 (P = 1.00). The DCP-VD change at POD30 in diabetic patients (− 1.90 ± 2.61%) was significantly different from that in controls (1.31 ± 2.61%) (P < 0.001). The amount of DCP-VD reduction was correlated with foveal and parafoveal thickening (r = 0.431, P = 0.051 and r = 0.514, P = 0.017, respectively), high cumulative dissipated energy (P = 0.032) and increased hemoglobin A1c concentration (P = 0.037). Conclusions: Phacoemulsification in diabetic patients caused transient reduction in DCP-VD, which was associated with poor glycemic control, surgical trauma, and postoperative macular thickening. Our results added a new dimension to our understanding of the complex biologic effects of cataract surgery in diabetic subjects.

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Section: Discussionmentioning

confidence: 99%

Transient reduction in macular deep capillary density on optical coherence tomography angiography after phacoemulsification surgery in diabetic patients

Wang

Chen

2020

BMC Ophthalmol

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“…Cataract surgery is important at several levels in the management of diabetic patients, not only for the visual rehabilitation purpose, but also, because it improves the accuracy of the diagnosis and treatment of the underlying retinopathy (17). Formerly considered a high-risk procedure due to the possibility of increasing the risk of retinopathy progression and the development or worsening of macular edema, it is currently considered safe due to the modern surgical techniques (17)(18)(19)(20) and effective pharmacological approaches (21,22). In our study, the incidence of postoperative cystoid macular edema or worsening of diabetic macular edema was low and progression of the retinopathy was not observed in any of the operated and nonoperated eyes; however, some of the eyes with the more advanced stages of retinopathy, both operated and nonoperated, required diabetic macular edema treatment during the follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, all participants had stabilized retinopathy, without any treatment in the months preceding the surgery. Lastly, the standard postoperative use of topical steroids in combination with nonsteroidal anti-in ammatory drugs in all patients associated to the use of coadjuvant intraoperative intravitreal injection of bevacizumab or triamcinolone in selected cases (preexistent diabetic macula edema, severe NPDR or PDR) may have contributed to achieve better anatomical and, consequently, functional results (21,22).…”

Section: Discussionmentioning

confidence: 99%

Visual Outcomes, Quality of Life and Satisfaction After Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes

Beato¹,

Torres-Costa²,

Esteves-Leandro³

et al. 2020

Preprint

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BackgroundDiabetic retinopathy (DR) and cataract are major complications that lead to significant visual impairment of diabetic patients. This study aims to compare the changes in visual acuity, quality of life and satisfaction after phacoemulsification between type 2 diabetic and nondiabetic patients.MethodsFifty-seven diabetic patients (37 with no diabetic retinopathy [DR], 11 with mild/moderate nonproliferative DR and 9 with severe nonproliferative/proliferative DR) and 45 controls were submitted to first-eye cataract surgery by phacoemulsification alone or with co-adjuvant intravitreal injection of bevacizumab or triamcinolone. National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was recorded preoperatively and 6 months after surgery; and satisfaction evaluated at 1-month. ResultsCorrected distance visual acuity (CDVA) of the operated eye at 1 and 6-months (p<0.001) was significantly higher than preoperative value in the controls and all diabetic subgroups. The final CDVA in the severe nonproliferative/proliferative DR subgroup was significantly lower compared to the controls and the remaining diabetic subgroups (p<0.05). The mean NEI VFQ-25 composite score significantly improved in both control (15.413.2 points) and diabetic (15.413.0 points) groups, without differences among the diabetic subgroups (p>0.05). Overall patient satisfaction was 93% in both control and diabetic groups. ConclusionThis study provides vision-related patient-reported outcomes that support the benefit from phacoemulsification in all stages of DR, as long as there is adequate monitoring and treatment of retinopathy.

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“…It is the leading cause of vision loss in elderly patients, causing visual impairment in about 30% of the population over 65 years old, but its incidence is also increasing in the younger population due to the exposition of UV radiation, smoke, use of steroids, increased incidence of diabetes and malnutrition [46,141]. Approximately 20% of cataract surgeries in the western population are performed on diabetic patients [142].…”

Section: Cataractmentioning

confidence: 99%

“…A recent clinical trial by McCafferty et al [146] on 662 patients evidenced that PCME was the most common complication after cataract surgery. Because of the higher sensitivity of the vascular bed in diabetic patients, approximately 4-12% of patients affected by diabetes mellitus [142,147] and up to 56% of patients with diabetic retinopathy [148] are expected to develop PCME after IOL implant. Ocular infection, often linked to endophthalmitis, is another possible adverse condition, and it is mostly caused by bacterial migration from the lid and conjunctiva to the intraocular space.…”

Section: Cataractmentioning

confidence: 99%

Therapeutic Ophthalmic Lenses: A Review

2020

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An increasing incidence of eye diseases has been registered in the last decades in developed countries due to the ageing of population, changes in lifestyle, environmental factors, and the presence of concomitant medical conditions. The increase of public awareness on ocular conditions leads to an early diagnosis and treatment, as well as an increased demand for more effective and minimally invasive solutions for the treatment of both the anterior and posterior segments of the eye. Despite being the most common route of ophthalmic drug administration, eye drops are associated with compliance issues, drug wastage by lacrimation, and low bioavailability due to the ocular barriers. In order to overcome these problems, the design of drug-eluting ophthalmic lenses constitutes a non-invasive and patient-friendly approach for the sustained drug delivery to the eye. Several examples of therapeutic contact lenses and intraocular lenses have been developed, by means of different strategies of drug loading, leading to promising results. This review aims to report the recent advances in the development of therapeutic ophthalmic lenses for the treatment and/or prophylaxis of eye pathologies (i.e., glaucoma, cataract, corneal diseases, or posterior segment diseases) and it gives an overview of the future perspectives and challenges in the field.

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Prevention of macular edema in patients with diabetes after cataract surgery

Cited by 31 publications

References 83 publications

Transient reduction in macular deep capillary density on optical coherence tomography angiography after phacoemulsification surgery in diabetic patients

Transient reduction in macular deep capillary density on optical coherence tomography angiography after phacoemulsification surgery in diabetic patients

Visual Outcomes, Quality of Life and Satisfaction After Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes

Therapeutic Ophthalmic Lenses: A Review

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