Does diabetic retinopathy increase the incidence of intraoperative complications of phacoemulsification surgery?

Abstract

Our results indicates that eyes with PDR are significantly more prone to IEPC, while the type of DM is not a predictor factor. DOP is longer in the eyes with PDR. In spite of NSAID use, SIM is more commonly observed in eyes with PDR.

Diabetes and cataracts

“…The decision to recommend cataract surgery should be based on the patient's visual acuity, visual impairment, and potential for functional benefits [1]. The presence of cataracts in patients with diabetes can make adequate examination of the retina and, when indicated, treatment of diabetic retinopathy (DR) technically more difficult [29]. Thus, cataract extraction tends to be more commonly performed in patients with diabetes than in patients without diabetes.…”

“…Cataract surgery becomes technically more challenging and carries a higher risk of complication in patients who exhibit poor pupillary dilation, or miosis, during surgery. Miosis is more common in patients with diabetes, in particular those with proliferative DR, and is more likely to develop intraoperatively in patients with diabetes when compared to patients without diabetes [29,32,33]. Preoperative use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and the use of epinephrine in the irrigating solution used intraoperatively have been used to treat intraoperative miosis [34,35].…”

“…Visual acuity can improve significantly after cataract surgery in patients with diabetes even in patients with underlying diabetic retinopathy [36,37]. However, patients undergoing cataract surgery who have underlying proliferative diabetic retinopathy appear to be at higher risk for postoperative complications [29]. The effect of cataract surgery on the progression of diabetic retinopathy has also been studied.…”

Progression of Diabetic Retinopathy and Maculopathy After Phacoemulsification Surgery

“…9 One explanation could be a higher rate of intraoperative complications such as surgically induce miosis, duration of phacoemulsification, posterior capsular rupture with vitreous loss, and postoperative miosis in patients with PDR as compared with patients with predominantly mild-to-moderate NPDR or no DR, in which case such a difference has not been observed. 16 Surgically induced miosis can make phacoemulsification more complicated and prolong the duration of phacoemulsification in patients with PDR. 16 This can affect the blood aqueous barrier significantly more severely in PDR patient populations, than those with NPDR or no DR, 17 and hence the higher rate of CSME incidence in more severe DR. 9 The resolution of CSME is also more guarded in patients with severe DR, as shown in a 1-year prospective study, in which retinopathy was found to be significantly more severe (median severe NPDR) in eyes in which CSME arising within 6 months of surgery failed to resolve within 1 year than in eyes in which it resolved (median mild NPDR).…”

Nepafenac-assisted mydriasis in a rabbit model

“…7,8 Severity of retinopathy is associated with frequency of miosis. 9 Excessive surgical trauma can also cause surgically induced miosis. Ocular tissues synthesize prostaglandins, which are known mediators of ocular inflammatory responses.…”