Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy

Han, Manbae; Song, Weilin; Conti, Thais F.; Conti, Felipe F.; Greenlee, Tyler; Hom, Grant L; Briskin, Isaac; Singh, Rishi P.; Talcott, Katherine E.

doi:10.1016/j.oret.2019.12.018

Cited by 6 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple recent studies have shown no significant difference between diabetics and nondiabetics in visual outcomes after uneventful phacoemulsification, unless diabetic patients had had previous laser treatment or significant macular edema. 24,25 The current study showed similar visual outcomes in diabetics in comparison to healthy patients, and this could be attributed to the exclusion of diabetic patients with retinopathy. HbA 1c percentage, duration of diabetes, and type of diabetes showed no correlation in our study with increased epithelial or corneal thickness.…”

Section: Discussionsupporting

confidence: 68%

<p>Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study</p>

Elmekawey¹,

Abdelaziz²,

Baradey³

et al. 2020

OPTH

View full text Add to dashboard Cite

Purpose: To compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients. Methods: Fifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography. Results: A significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients. Conclusion: Phacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.

show abstract

Section: Discussionsupporting

confidence: 68%

<p>Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study</p>

Elmekawey¹,

Abdelaziz²,

Baradey³

et al. 2020

OPTH

View full text Add to dashboard Cite

show abstract

“…Patients with late-stage AMD or severe DR may have limited gains in visual function with cataract surgery. [37][38][39][40] Studies 41,42 have found a higher prevalence of myopia in Asian American populations, and high myopia is associated with worse prognosis after cataract surgery. 43 It is possible that some patients did not receive follow-up care postoperatively, and so corresponding BCVA was not available.…”

Section: Discussionmentioning

confidence: 99%

“…The current study found worse outcomes associated with ocular comorbidities similar to previous studies. [37][38][39][40]46 Patients with AMD have less postoperative improvement compared with those without retinal disease, 38,40 and patients with glaucoma are more likely to have refractive surprise after cataract surgery. 46 Severe DR and poor preoperative VA are associated with worse outcomes.…”

Section: Fewer Letters (Approximately 1 Line Inmentioning

confidence: 99%

See 1 more Smart Citation

Refractive Outcomes After Immediate Sequential vs Delayed Sequential Bilateral Cataract Surgery

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Approximately 2 million cataract operations are performed annually in the US, and patterns of cataract surgery delivery are changing to meet the increasing demand. Therefore, a comparative analysis of visual acuity outcomes after immediate sequential bilateral cataract surgery (ISBCS) vs delayed sequential bilateral cataract surgery (DSBCS) is important for informing future best practices. OBJECTIVETo compare refractive outcomes of patients who underwent ISBCS, short-interval (1-14 days between operations) DSBCS (DSBCS-14), and long-interval (15-90 days) DSBCS (DSBCS-90) procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used population-based data from the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry. A total of 1 824 196 IRIS Registry participants with bilateral visual acuity measurements who underwent bilateral cataract surgery were assessed. EXPOSURES Participants were divided into 3 groups (DSBCS-90, DSBCS-14, and ISBCS groups) based on the timing of the second eye surgery. Univariable and multivariable linear regression models were used to analyze the refractive outcomes of the first and second surgery eye. MAIN OUTCOMES AND MEASURES Mean postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) after cataract surgery. RESULTSThis study analyzed data from 1 824 196 patients undergoing bilateral cataract surgery (mean [SD] age for those <87 years, 70.03 [7.77]; 684 916 [37.5%] male). Compared with the DSBCS-90 group, after age, self-reported race, insurance status, history of age-related macular degeneration, diabetic retinopathy, and glaucoma were controlled for, the UCVA of the first surgical eye was higher by 0.41 (95% CI, 0.36-0.45; P < .001) letters, and the BCVA was higher by 0.89 (95% CI, 0.86-0.92; P < .001) letters in the DSBCS-14 group, whereas in the ISBCS group, the UCVA was lower by 2.79 (95% CI, −2.95 to −2.63; P < .001) letters and the BCVA by 1.64 (95% CI, −1.74 to −1.53; P < .001) letters. Similarly, compared with the DSBCS-90 group for the second eye, in the DSBCS-14 group, the UCVA was higher by 0.79 (95% CI, 0.74-0.83; P < .001) letters and the BCVA by 0.48 (95% CI, 0.45-0.51; P < .001) letters, whereas in the ISBCS group, the UCVA was lower by −1.67 (95% CI, −1.83 to −1.51; P < .001) letters and the BCVA by −1.88 (95% CI, −1.98 to −1.78; P < .001) letters. CONCLUSIONS AND RELEVANCEThe results of this cohort study of patients in the IRIS Registry suggest that compared with DSBCS-14 or DSBCS-90, ISBCS is associated with worse visual outcomes, which may or may not be clinically relevant, depending on patients' additional risk factors. Nonrandom surgery group assignment, confounding factors, and large sample size could account for the small but statistically significant differences noted. Further studies are warranted to determine whether these factors should be considered clinically relevant when counseling patients before cataract surgery.

show abstract

“…Apart from the incidence of DME after cataract surgery, it is also essential to understand how DME progresses, which is reflected by visual acuity after cataract surgery in patients with different degrees of DR. Research evaluated diabetic patients’ change in BCVA throughout a year after cataract surgery ( 43 ). Diabetic eyes without DR before surgery ( n = 138) and eyes with NPDR ( n = 125) gained a median of 11.0 and 10.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from 65.0, respectively.…”

Section: Association Of Dme and Cataract Surgerymentioning

confidence: 99%

Optimizing treatment for diabetic macular edema during cataract surgery

et al. 2023

View full text Add to dashboard Cite

Diabetic macular edema (DME) causes visual impairment in diabetic retinopathy (DR). Diabetes mellitus is a global epidemic and diabetic individuals are at risk of developing DR. Approximately 1 in 10 diabetic patients suffers from DME, which is the commonest cause of vision-threatening DR at primary-care screening. Furthermore, diabetes predisposes to a higher frequency and a younger onset of cataract, which further threatens vision in DME patients. Although cataract extraction is an effective cure, vision may still deteriorate following cataract surgery due to DME progression or recurrence, of which the risks are significantly higher than for patients without concurrent or previous history of DME at the time of operation. The management of pre-existing DME with visually significant cataract is a clinical conundrum. Deferring cataract surgery until DME is adequately treated is not ideal because of prolonged visual impairment and maturation of cataract jeopardizing surgical safety and monitoring of DR. On the other hand, the progression or recurrence of DME following prompt cataract surgery is a profound disappointment for patients and ophthalmic surgeons who had high expectations for postoperative visual improvement. Prescription of perioperative anti-inflammatory eye drops is effective in lowering the risk of new-onset DME after cataract surgery. However, management of concurrent DME at the time of cataract surgery is much more challenging because DME is unlikely to resolve spontaneously even with the aid of anti-inflammatory non-steroidal or steroid eye drops. A number of clinical trials using intravitreal injection of corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) as first-line therapy have demonstrated safety and efficacy to treat DME. These drugs have also been administered perioperatively for the prevention of DME worsening in patients undergoing cataract surgery. This article reviews the scientific evidence to guide ophthalmologists on the efficacy and safety of various therapies for managing patients with DME who are particularly vulnerable to cataract surgery-induced inflammation, which disintegrates the blood–retinal barrier and egression of fluid in macular edema.

show abstract

Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy

Cited by 6 publications

References 27 publications

<p>Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study</p>

<p>Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study</p>

Refractive Outcomes After Immediate Sequential vs Delayed Sequential Bilateral Cataract Surgery

Optimizing treatment for diabetic macular edema during cataract surgery

Contact Info

Product

Resources

About