Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study

Abstract

Background The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). Methods DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. Results The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively ( p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively ( p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (−2.6 ± 3.5 letters vs −8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups. Conclusion Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.

Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study

“…[ 22 ] As reported previously, the predictors of poor outcomes of DME following cataract surgery in patients with diabetes include early DME; hypertension; and the aqueous levels of VEGF, interleukin-6, and proteins. [ 23 , 24 ] The most severe aspect of DME is attributed to 2 parameters. First, the disruption of retinal tissue caused by retinal edema is not reversible.…”

Enhancing Diabetic Macular Edema Treatment Outcomes: Exploring the ESASO Classification and Structural OCT Biomarkers

“…While the ESASO Classification has already provided valuable descriptive insights on DME [ 5 , 6 , 14 ], its clinical relevance required further validation. To address this knowledge gap, the objective of this retrospective multicenter study was to assess the therapeutic response to intravitreal agents in eyes at different stages of DME progression.…”

From diagnosis to prognosis: A paradigm shift for multimodal imaging in assessing diabetic macular edema

“…14 Early DME is a poor prognostic factor after cataract surgery, and close pre- and postoperative monitoring has been advocated in eyes with early DME. 15 Finally, OCT allows quantitative measurements of the choroid. Diabetic eyes have choroidal depletion that matches DR severity; moreover, eyes with DME tend to have a higher lumen-to-stroma ratio in the macula than eyes without DME.…”