Changes in diabetic macular oedema after phacoemulsification surgery (original) (raw)
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Journal of Intellectual Disability - Diagnosis and Treatment,, 2020
A cataract is an ocular complication of diabetes mellitus, and the risk of developing diabetic macular oedema (DME) increases in cataract surgery. This randomized, single-blind clinical trial study was conducted on 45 eyes (39 patients) with stable diabetic retinopathy with cataract to compare the efficacy of three therapeutic procedures in the prevention of DME after phacoemulsification through intraocular lens implantation. After cataract surgery by phacoemulsification, the patients were randomly assigned into three groups. The group A received 1.25 mg of intravitreal bevacizumab, and group B received a sub-tenon injection of 40 mg triamcinolone at the end of the surgery. The group C received topical diclofenac drops every 8h for four weeks after the surgery. Results showed there was no significant difference in the demographics and clinical features, central macular thickness, and systemic condition of the three groups at the beginning of the study. There was a significant difference between the preoperative and postoperative periods (i.e., three months after surgery) in the three groups regarding mean macular thickness; however, the difference among the three groups was not significant in the post-operative periods. The DME after cataract surgery occurred in 4 eyes (26.67%) in the diclofenac group and three eyes (20.00%) in the intravitreal bevacizumab and three eyes (20.00%) in sub-tenon triamcinolone groups. According to results, the administration of these three therapeutic procedures can be beneficial in the prevention of DME in patients with cataract and diabetic retinopathy.
Clinical & Experimental Ophthalmology, 2019
Importance: There are limited data on real-world outcomes of cataract surgery in eyes receiving intravitreal treatments for diabetic macular oedema (DMO). Background: Cataract surgery may exacerbate edema in some eyes with DMO resulting in inferior outcomes. Design: Matched, case-controlled retrospective study of observational data from routine clinical practice. Participants: Eyes receiving intravitreal treatments for DMO tracked in the Fight Retinal Blindness! Registry. Methods: Eyes that underwent cataract surgery were identified and matched 1:1 with phakic controls also receiving intravitreal injections for DMO. We also assessed potential factors that were associated with better visual acuity (VA) outcomes. Main Outcome Measures: Change in VA 6 months after cataract surgery. Results: Cataract surgery was identified in 208 eyes of 156 patients of which 147 eyes had 6-months of observations before and after the surgery. The mean VA 6 months after surgery improved by 10.6 letters and was similar to their matched controls (68.8 versus 69.2 letters; p=0.8). Mean CST both 6 months before (341μm) and after (360μm) surgery were similar (p=0.08). However, these eyes had thicker maculae and they received more injections than their matched phakic controls both before and after surgery. Eyes with worse VA before surgery and those that had received intravitreal treatment in the 4 weeks preceding surgery were more likely to gain vision. Conclusions and relevance: Visual outcomes of cataract surgery in eyes receiving intravitreal therapy for DMO were reasonably better. Their maculae were thicker and required more injections in the 6 months before and after surgery than their phakic controls.
JAMA Ophthalmology, 2013
IMPORTANCE The incidence of development or worsening of macular edema (ME) is variable in eyes without diabetic ME (DME) undergoing cataract surgery. OBJECTIVE To estimate the incidence of central-involved ME 16 weeks following cataract surgery in eyes with diabetic retinopathy without definite central-involved DME preoperatively. DESIGN, SETTING, AND PARTICIPANTS In a multicenter, prospective, observational study, 293 participants with diabetic retinopathy without definite central subfield thickening on optical coherence tomography (OCT) underwent cataract surgery. EXPOSURE Cataract extraction surgery performed within 28 days of enrollment of eyes without DME in individuals with diabetes mellitus. MAIN OUTCOMES AND MEASURES Development of central-involved ME defined as the following: (1) OCT central subfield thickness of 250 μm or greater (time-domain OCT) or 310 μm or greater (spectral-domain OCT) with at least a 1-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; (2) at least a 2-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; or (3) nontopical treatment for ME received before the 16-week visit with either of the OCT criteria met at the time of treatment. RESULTS The median participant age was 65 years. The median visual acuity letter score was 69 letters (Snellen equivalent 20/40). Forty-four percent of eyes had a history of treatment for DME. Sixteen weeks postoperatively, central-involved ME was noted in 0% (95% CI, 0%-20%) of 17 eyes with no preoperative DME. Of eyes with non-central-involved DME, 10% (95% CI, 5%-18%) of 97 eyes without central-involved DME and 12% (95% CI, 7%-19%) of 147 eyes with possible central-involved DME at baseline progressed to central-involved ME. History of DME treatment was significantly associated with central-involved ME development (P < .001). CONCLUSIONS AND RELEVANCE In eyes with diabetic retinopathy without concurrent central-involved DME, presence of non-central-involved DME immediately prior to cataract surgery or history of DME treatment may increase the risk of developing central-involved ME 16 weeks after cataract extraction.
Macular Changes after Uneventful Phacoemulsification in Diabetic Patients in a Tertiary Hospital
Iris Publishers LLC, 2018
Purpose was to evaluate the subclinical influence of uncomplicated phacoemulsification surgery on foveal thickness in the early postoperative period. Materials and methods: This study was conducted on 50 eyes of 44 subjects who underwent uneventful phacoemulsification in King Faisal Specialist Hospital and Research center (KFSH&RC). They were divided into Groups: Diabetes mellitus group consisted of 25 eyes (21 diabetic patients), Control group consisted of 25 eyes (23 non-diabetic patients). Best corrected visual acuity and Optical coherence tomography were recorded preoperatively, 2 weeks, one month and two months postoperative. Results: Despite that Mean foveal thickness was stable 2 weeks, 1 month and 2 months postoperative in the control group; our study showed significant increase in mean foveal thickness (MFT) 1 month and 2 months post-operative in diabetic group compared to the 2nd week postoperative. However, after converting the MFT into Log OCT, the MFT in diabetic and control groups was stable postoperatively without any step deterioration. Conclusion: Diabetic patients may need prophylactic therapy before cataract surgery.
2022
Objective: To compare OCT changes on macular thickness after uneventful phacoemulsification in diabetic and non-diabetic patients. Methodology: A prospective comparative study was conducted at Shaheed Mohtarma Benzair Bhutto Medical College Lyari and Sindh Government, Lyari General Hospital Lyari Karachi consisting of 30 patients that were to undergo phacoemulsification surgery and subsequent intraocular lens implantation (IOL) procedure. They were divided into three equal groups, first groups was the control groups without diabetes, second group consisted of patients with confirmed diabetes mellitus with no diabetic retinopathy and the third group was with diabetes mellitus as well as diabetic retinopathy (DR). Preoperative macular thickness and visual acuity was assessed of all the patients. After the successful completion of the surgery macular thickness using OCT and BCVA was assessed once again after 1 st week, 1 st month, and 6 th month. Data was analyzed using SPSS Version 20.0 and comparison among groups was done using independent ttest, with P-value set at ≤0.05 to be considered as significantly different. Results: In total 30 patients participated in the study. 18(60%) were male and 12(40%) were female patients in the study. The mean age of the participants in the study was 58.43±8.74.Increase in macular thickness was seen in all groups but it was less in the control group and diabetic group without DR, however macular thickness remained high in the group with DR. BCVA improved in all groups but least improvement was seen in the group with DR. No Medicine Volume 50, Issue 1, January 2022, 3 significant difference was observed in the macular thickness when comparing groups preoperatively (P=0.082) and during the 1 st week (P=0.122). Significant difference was observed in the macular thickness when comparing groups one month (P=0.018) and six month (P=0.002) post-operatively. No significant difference was observed in the BCVA when comparing groups pre-operatively (P=0.021) and during the 1 st week (P=0.016). Significant difference was observed in the BCVA when comparing groups one month (P=0.007) and six month (P<0.001) postoperatively. Conclusion: Diabetic Retinopathy among Diabetics affects the macular thickness on OCT following uneventful phacoemulsification
Eye, 2022
BACKGROUND/OBJECTIVES: To characterise the prevalence and three-year progression of centre-involving diabetic macular oedema (CI-DMO) in minimal to moderate non-proliferative diabetic retinopathy, using optical coherence tomography (OCT) and measurements of retinal fluid using tissue optical reflectivity ratios (OCT-Leakage). METHODS/METHODS: Seventy-four eyes from 74 patients were followed in a 3-year prospective longitudinal observational cohort of type 2 diabetes (T2D) patients using spectral-domain optical coherence tomography (SD-OCT), OCT-Angiography (OCT-A) and OCT-Leakage (OCT-L). Eyes were examined four times with 1-year intervals. Sixteen eyes (17.8%) were excluded from the analysis due to quality control standards. Retinal oedema was measured by central retinal thickness and retinal fluid by using optical reflectivity ratios obtained with the OCT-L algorithm. Vessel density was measured by OCT-A. Thinning of the ganglion cell and inner plexiform layers (GCL + IPL) was examined to identify retinal neurodegenerative changes. Diabetic retinopathy ETDRS classification was performed using the seven-field ETDRS protocol. RESULTS: CI-DMO was identified in the first visit in 9% of eyes in ETDRS groups 10-20, 10% of eyes in ETDRS group 35 and 15% of eyes in ETDRS groups 43-47. The eyes with CI-DMO and subclinical CI-DMO showed a progressive increase in retinal extracellular fluid during the 3-year period of follow-up. The eyes with CI-DMO and increased retinal extracellular fluid accumulation were associated with vision loss. CONCLUSIONS: The prevalence of subclinical CI-DMO and CI-DMO in the initial stages of NPDR occurs independently of severity grading of the retinopathy, showing progressive increase in retinal extracellular fluid and this increase is associated with vision loss (82% 9 out of 11 cases).
Retina-the Journal of Retinal and Vitreous Diseases, 2011
Purpose: To report visual results and anatomical outcome after uncomplicated phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Methods: This retrospective noncomparative study included 22 eyes of 19 diabetic patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Main outcome measures included visual acuity and foveal thickness (FT) changes as assessed by optical coherence tomography. Wilcoxon test was used for statistical analysis. Results: Mean follow-up time was 11.9 6 8.75 months. Mean FT increased by 20.5 6 67.6 mm (8.4%), with a mean preoperative FT of 237 6 69 mm compared with a mean postoperative FT of 257.6 6 89.8 mm (P = 0.236). Foveal thickness increased by at least 20% in 6 eyes (27.3%), remained within 20% in 14 eyes (63.6%), and decreased by 20% in 2 eyes (9.1%). Visual acuity improved by $2 lines in 16 eyes (72.7%) and remained stable in 6 eyes (27.3%). Visual acuity was 20/40 or better in 11 eyes (50%). Conclusion: Moderate but insignificant increase in FT was observed after phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Prospective studies with a large number of patients are warranted for a more reliable conclusion.
JPMA. The Journal of the Pakistan Medical Association, 2017
To know the outcomes of cystoid macular oedema after phacoemulsification in patients with and without type 2 diabetes mellitus using optical coherence tomography. This non-concurrent, clinical, prospective study was carried out at Al-Ibrahim Eye Hospital, Karachi, from January to August 2015. After phacoemulsification with injectable posterior chamber intraocular lens implantation, eyes of patients were analysed. The patients were divided into diabetic and non-diabetic groups visual acuity, optical coherence tomography and dilated fundus examination were performed preoperatively (baseline) and post-operative 1st week and 6th week. SPSS 20 was used for data analysis. Of the 100 subjects, there were 50(50%) each in diabetic and non-diabetic group. Subsequently, 14(14%) patients were lost to follow-up, and 86 eyes of 86(86%) patients were analysed. Of them, 37(43%) were male and 49(57%) were female. The mean age of participants was 52.21±7.43 years (range: 38-62years). The non-diabetic...
IP Innovative Publication Pvt. Ltd., 2019
Purpose: To assess quantitative changes of the macula after cataract surgery using optical coherence tomography (OCT) in diabetic eyes and to estimate the incidence of development of macular edema (ME) in type II diabetic eyes. Materials and Methods: In this prospective observational case control study, 100 eyes out of which 50 are of type II diabetic patients and 50 are non-diabetic patients who underwent phacoemulsification surgery with acrylic foldable IOL lens implantation were evaluated at post op day 1, day 7, 1 month and 3 months post operatively. Macular thickness as described in early treatment of diabetic retinopathy study (ETDRS) with OCT was evaluated in 9 zones. 4 patients developed DME at 1 month after surgery and were withdrawn from further analysis. Result: The mean central foveal thickness of the diabetic group preoperatively was 231.06±38.785µ. The increase in central foveal thickness was statistically significant at 1 month postoperatively (p=0.004). The mean perifoveal thickness changes in the inferior and temporal quadrants was also statistically significant at 1 month postoperatively (p=0.002). However, the overall change in macular thickness was found to be insignificant at 3 months postoperatively. The incidence of diabetic macular edema was found to be 8%. Conclusion: We found that after uncomplicated phacoemulsification, changes in macular thickness as measured by OCT was without any significance. Keywords: Cataract, Diabetes, Macular edema, OCT.
The British journal of ophthalmology, 2017
To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery. Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annu...