one percent (246) said they do not stop other anticoagulants (including aspirin, clopidogrel, heparins and novel oral antiocoagulants) prior to surgery. Seventy-eight percent (236) of consultants cancelled based on blood glucose, with 40% (121) stating above 25 mmol/L, and 32% (97) above 15 mmol/L. Of all the criteria, heart rate gave the most variable response, with only 40% (123) considering it as a reason for cancellation. There was a huge variety in the upper limit, and symptomatic tachycardia understandably was the most important reason (14.8%, 45) rather than the rate. Consultants across the UK show some consensus on when to cancel patients in relation to blood pressure, blood glucose, INR level and most do not routinely stop other forms of anticoagulation. However, there remains some variability in practice, which is understandable given the lack of specific guidance at present. Studies looking at the influence that these factors may have on cataract surgery are currently limited. A national audit looking at these parameters in relation to complications may be warranted. Our survey highlights a need for more exploration into the immediate pre-operative management of patients.
Background: Diabetic macular oedema (DMO) is the leading cause of sight impairment in working age populations in developed countries. Current first line treatment for centreinvolving DMO involves intravitreal anti-VEGF but treatment response can be variable. In this retrospective, real world, multi-centre cohort study, we aim to identify ocular and systemic characteristics that correlate with anatomical and functional outcomes for treatment-naive DMO patients treated with intravitreal aflibercept. Methods: Retrospective multicentre cohort study of treatment-naive DMO patients initiated on aflibercept at three North West London hospitals between 2016 and 2018. Baseline systemic and ocular factors, best corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months were determined and statistically analysed. Results: A total of 270 eyes of 221 DMO patients met inclusion criteria. Mean age was 62.8 ± 12.1, mean baseline HbA1c was 67 ± 20 mmol/mol, and mean eGFR was 72 mL/min/ 1.7m 2 . Mean number of aflibercept injections at 12 months was 6.2. Better baseline BCVA, lower baseline CMT, and absence of epiretinal membrane (ERM) were associated with better BCVA at 12 months whilst lower baseline CMT and proliferative retinopathy status were associated with lower CMT at 12 months. Conclusion:Our study is the largest real-world dataset examining factors influencing functional and anatomical response to aflibercept in DMO in the UK. Older age, lower baseline BCVA, higher baseline CMT and more severe diabetic retinopathy were associated with poorer visual acuity at 12 months and prioritisation of these patients within a pressured healthcare setting is recommended.
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