Cataract-Surgery Adjuncts Improve Vision in Diabetic Macular Edema

By Reuters Staff

March 11, 2019

NEW YORK (Reuters Health) - Both intravitreous bevacizumab (BVB) and triamcinolone acetate (TA) improve outcomes when given as an adjunct to cataract surgery in patients with diabetic macular edema (DME), a new randomized controlled trial shows.

But improvement in central macular thickness (CMT) was sustained only in those who received TA, Dr. Rathika Kandasamy of the Royal Victorian Eye and Ear Hospital in East Melbourne, Australia, and colleagues found.

DME is associated with worse visual outcomes after cataract surgery, while the surgery itself may promote inflammation and in turn worsen DME, the authors note in the British Journal of Ophthalmology, online February 28.

In the Diabetic Macular Edema at the time of Cataract Surgery (DIMECAT) trial, they randomly assigned patients who had significant center-involving DME or a history of DME to receive intravitreous BVB 1.25 mg or TA 4 mg during cataract surgery.

Data was available at six months for 61 eyes from 58 patients. Improvement of visual acuity was similar for the TA and BVB groups, with mean letter gains of 21.4 and 17.3, respectively.

CMT was reduced by 51.4 um in the TA group, while it increased by 15.6 um in the BVB group. Twenty-four percent of the TA group required retreatment at six months, compared to 57% of the BVB group.

TA inhibits both inflammation and angiogenesis, while BVB targets vascular endothelial growth factor only, which may account for the differences in outcomes, the authors note.

"These findings provide further evidence in favour of the pathogenesis of (DME) being due to a combination of inflammatory cytokines and not purely VEGF levels, a conclusion that is echoed in results from other groups," they add.

"These findings confirm the earlier reported outcomes in our preliminary paper and suggest that the standard of care for all patients with (DME) undergoing cataract surgery should be to receive either agent intraoperatively and postoperatively as required," the authors write.


Br J Ophthalmol 2019.