Changes in Diabetic Macular Oedema After Phacoemulsification Surgery

K Hayashi; C Igarashi; A Hirata; H Hayashi

Disclosures

Eye. 2009;23(2):389-396. 

In This Article

Abstract and Introduction

Purpose. To quantitatively examine changes in macular oedema after phacoemulsification surgery in eyes with diabetic retinopathy (DR) and in eyes without DR.
Methods. Thirty-four eyes with DR and 34 eyes with no DR scheduled for phacoemulsification surgery were recruited. Foveal thickness and macular volume were measured using optical coherence tomography preoperatively and at 3, 6, and 12 months postoperatively. Grade of diabetic macular oedema was also examined.
Results. Preoperatively, there were no significant differences between groups in foveal thickness and macular volume. The foveal thickness increased by 20.3% in the DR group and by 6.0% in the no DR group at 3 months after surgery, but thereafter decreased gradually. When comparing the groups, the foveal thickness and macular volume were significantly greater in the DR group than in the no DR group at 3 months postoperatively. The grade of macular oedema worsened in eight eyes (23.5%) in the DR group, and in one (2.9%) in the no DR group: the incidence was significantly greater in the DR group ( P=0.0272). However, the oedema that occurred after surgery resolved spontaneously in three (33.3%) of the nine eyes.
Conclusions. The degree of diabetic macular oedema increases up to 3 months after cataract surgery, but thereafter decreases gradually. Grade of diabetic macular oedema also worsens up to 3 months, but certain percent of macular oedema that occurs after surgery resolves spontaneously. These changes are more prominent in eyes with DR than in eyes with no DR.

A number of studies have shown that visual outcome following cataract surgery in diabetic patients depends primarily on the status of macular oedema.[1,2,3,4,5,6,7] Previous reports have described many diabetic patients who developed severe maculopathy, retinopathy, and/or neovascular glaucoma following cataract surgery.[5,8,9,10,11,12] Because it is important to be able to predict long-term visual effects before cataract surgery is performed, surgeons need to have a better understanding of the natural course of diabetic macular oedema in addition to diabetic retinopathy (DR) after cataract surgery.

It has been demonstrated that DR progresses in approximately 10–30% of patients after cataract surgery,[2,6,13,14,15,16,17] although some authors have hypothesized that the progression of DR after cataract surgery is due simply to the natural course of the condition, and that the progression is independent of the surgery.[18,19,20,21] In these studies, the most significant predictor for progression of DR has been the status of the DR at the time of the cataract surgery.[13,14,15,16,22,23]

Similarly, diabetic macular oedema has been shown to worsen after cataract surgery,[24,25,26] although controversy remains as to the incidence of this worsening.[7,27] Some studies have shown that there are two types of worsening of macular oedema after surgery: transient pseudophakic oedema that spontaneously resolves such as Irvine–Gass syndrome[28,29,30] and actual progression of diabetic maculopathy. It has also been suggested that macular oedema tends to show actual worsening in eyes afflicted with DR at the time of cataract surgery.[14] Distinguishing transient oedema from substantial progression of maculopathy is important to the timing of treatment for the macular oedema, including laser photocoagulation,[31] vitrectomy,[32,33,34] and triamcinolone injection.[35,36,37] However, until recently, there had been no quantitative study to examine the progression of diabetic macular oedema after cataract surgery. A recent study described by Kim et al[38] showed a short-term increase of macular thickness after cataract surgery.

The purpose of the study described herein was to investigate changes in macular oedema after phacoemulsification surgery in eyes with DR and in eyes with no DR. To compare the degree of macular oedema quantitatively, we measured periodically the foveal thickness and macular volume using optical coherence tomography.

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