Progression of Diabetic Retinopathy and Maculopathy After Phacoemulsification Surgery

Abstract

Patients with diabetes have a 2 to 4 times higher risk of cataract development compared with the general population. Cataract remains one of the major causes of blindness in patients with diabetes. 1 The progression of diabetic retinopathy and maculopathy after phacoemulsification surgery has been a subject of debate. Some studies report an increased risk of progression, 2 whereas others report that this progression simply represents the natural course of the disease rather than a surgical outcome. 3-8 The purpose of our article is to review the recent studies on this subject for evaluation and management of patients with diabetes with concomitant cataract. ' Progression of Diabetic Retinopathy After PhacoemulsificationA systematic review of literature revealed 5 prospective case control studies in which type I and type II patients with diabetes underwent monocular phacoemulsification procedure and were followed for 6 to 12 months to study the progression of diabetic retinopathy (DR) compared with the fellow phakic nonoperated eye, when both eyes had symmetrical DR at baseline (Table 1). [4][5][6][7][8] The table summarizes the number of patients in each study, the preoperative DR stage of the operated and nonoperated eyes that progressed after cataract surgery, visual outcome, www.internat-ophthalmology.com | 155

Diabetic Retinopathy: A Position Statement by the American Diabetes Association

“…Pregnancy and puberty can accelerate these changes (12,13). Cataract surgery has not been definitely demonstrated by recent studies to accelerate the progression of diabetic retinopathy, especially in the more recent era of treating both diabetic macular edema (DME) and PDR with the use of anti–vascular endothelial growth factor (anti-VEGF) agents (14). …”

Pseudophakic cystoid macular edema

“…It may be difficult to distinguish PCME from progression of diabetic macular edema (DME). Cataract surgery was historically thought to worsen diabetic retinopathy, but recent studies may not support this theory [12,13]. Postoperative macular edema usually develops in those with a prior history of DME [14], which, if exists at the time of surgery, is unlikely to resolve spontaneously [15].…”

Cistoidni makularni edem nakon operacije katarakte

“…In these cases, it is extremely difficult to differentiate between CME and diabetic macular edema since diabetic macular edema patients tend to have worse vision after cataract surgery 20 . Patients with prior treated macular edema, regardless of treatment choice, and patients with non centralinvolved macular edema are at greater risk of worsening conditions although there is controversy regarding the risk of diabetic retinopathy progression 20,21 . For practical purposes, patients suffering from central-involved or non central-involved macular edema, history of previously treated macular edema and severe retinopathy should be properly treated before surgery 20 .…”