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Cataract/Anterior Segment
Conference Roundup

Do Not Delay Cataract Surgery in These Individuals

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Patients with diabetes but without diabetic retinopathy were just as likely as those without diabetes to achieve 20/20 postop best-corrected visual acuity (BCVA) after undergoing phacoemulsification, according to a recent retrospective cohort study. And while this was not the case in those with diabetic retinopathy, even those individuals experienced improved vision postoperatively. 

The results were from a team led by Neal H. Shorstein, MD, researcher and associate chief of quality at Kaiser Permanente in Walnut Creek, CA. They were presented by Geraldine R. Slean, MD, an ophthalmology resident at the California Pacific Medical center, during the American Academy of Ophthalmology’s 2018 annual meeting in Chicago. 

Dr. Shorstein sought to ascertain BVCA outcomes after phacoemulsification in patients with and without diabetes, and to further evaluate the impact of diabetic retinopathy severity, diabetes duration, insulin usage, and A1C level on postoperative BCVA. More than 100,000 eyes in ~65,000 participants who underwent noncomplex phacoemulsification were included. Those with preoperative macular edema, type 1 diabetes, prior surgery by a retina or oculoplastic specialist, or endophthalmitis diagnosed in the prior year were excluded. Investigators looked at preoperative BCVA up to 1 year before surgery, as well as postoperative acuity obtained 3 weeks to 1 year postoperatively.  

~One-third of participants (~22,000) had diabetes. Among them, 80% did not have diabetic retinopathy, 15% had non-proliferative diabetic retinopathy (NPDR), and 4% had proliferative diabetic retinopathy (PDR). Additionally: 
⦁    37% had diabetes for <10 years; 41% had it for ≥10 years.
⦁    20% were using insulin.
⦁    Only 42% had their A1C level measured in the 90 days before surgery. 

Average preoperative and postoperative BCVA were similar in patients without diabetes (20/68 and 20/25, respectively) and those with diabetes but without diabetic retinopathy (20/71 and 20/26, respectively). Patients with diabetes but without retinopathy had the same odds of attaining 20/20 BCVA as those without diabetes. 

Conversely, patients diagnosed with retinopathy had an increased chance of postoperative BCVA of 20/25 or worse, vs those without diabetes, as follows: 
⦁    Mild NPDR: 19% higher odds
⦁    Moderate NPDR: 89% higher 
⦁    Severe NPDR: >twice the risk
⦁    PDR: >3 times the risk

Additionally, increased diabetes duration and insulin usage increased the likelihood of worse BCVA. However, A1C level was not associated with this outcome.  

All patients gained 4 lines of vision. Change in logMAR was not significantly impacted by stage of diabetic retinopathy, diabetes duration, insulin usage, or comorbidities. Those with preoperative A1C ≥9 experienced a half-line greater improvement than those whose A1C was <6.5. Less improvement was seen in older patients and those with ocular comorbidities except prior vitreoretinal procedures. 

“Cataract surgery should not be delayed based on A1C levels,” noted Dr. Slean. “Timely cataract surgery can be a great benefit to these patients.”

Slean G. Visual Outcomes After Cataract Surgery in Patients with Diabetes. Talk presented at: AAO 2018 annual meeting; October, 26-30, 2018; Chicago.

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