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Chilmonczyk M, Gołaszewska K, Saeed E, Konopińska J. Preserflo MicroShunt Implantation: A Narrative Review of Its Standalone Benefits vs. Combined Use with Phacoemulsification in Managing Open-Angle Glaucoma. Ophthalmol Ther 2025; 14:41-54. [PMID: 39636489 PMCID: PMC11724813 DOI: 10.1007/s40123-024-01068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 10/30/2024] [Indexed: 12/07/2024] Open
Abstract
Glaucoma and cataract often coexist. Patients with both conditions who qualify for surgical treatment may undergo either a combined surgical procedure or sequential treatments such as cataract surgery followed by an antiglaucoma procedure. A combined procedure with phacoemulsification is related to an increased risk of fibrosis of the filtering bleb; however, it is a rational approach for patients with high intraocular pressure and clinically significant lens opacification. Trabeculectomy has been a traditional filtration procedure for decades, effectively lowering intraocular pressure. It is highly effective; however, it may cause sight-threatening complications. The Preserflo MicroShunt, introduced less than a decade ago in the field of glaucoma surgery, has shown similar hypotensive efficacy to trabeculectomy, and is a less invasive procedure with a better safety profile. Despite their shared mechanism of action to reduce intraocular pressure, the two procedures differ in the extent of scleral incision and filtration bleb morphology, which may influence the extent of the post-surgery inflammation process. This review evaluated and compared reports on the efficacy and safety of Preserflo MicroShunt implantation as a standalone procedure versus combined with cataract removal in surgical treatment for patients with open-angle glaucoma and concomitant cataract.
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Affiliation(s)
- Małgorzata Chilmonczyk
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24 A STR, 15-276, Bialystok, Poland
| | - Kinga Gołaszewska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24 A STR, 15-276, Bialystok, Poland
| | - Emil Saeed
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24 A STR, 15-276, Bialystok, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Bialystok, M. Sklodowskiej-Curie 24 A STR, 15-276, Bialystok, Poland.
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Tang YF, Duan ZH. Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients. World J Clin Cases 2024; 12:1733-1741. [PMID: 38660074 PMCID: PMC11036478 DOI: 10.12998/wjcc.v12.i10.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/25/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.
AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods.
METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication.
RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.
CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.
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Affiliation(s)
- Yi-Fei Tang
- Department of Glaucoma and Cataracts, Han Yang Eyegood Ophthalmic Hospital, Wuhan 430056, Hubei Province, China
| | - Zhi-Hui Duan
- Department of Glaucoma and Cataracts, Han Yang Eyegood Ophthalmic Hospital, Wuhan 430056, Hubei Province, China
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Sruthi R, Saikumar SJ, Gopalakrishnan M. Progression of diabetic retinopathy following uncomplicated phacoemulsification: A prospective study from South India. Oman J Ophthalmol 2024; 17:72-77. [PMID: 38524349 PMCID: PMC10957061 DOI: 10.4103/ojo.ojo_292_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 03/26/2024] Open
Abstract
AIM The aim of this study was to study the progression of diabetic retinopathy (DR) and macular edema in uncomplicated phacoemulsification in patients with diabetes mellitus with a follow-up of 6 months. METHODS A prospective, nonrandomized study was conducted on patients with established or no DR in a known case of diabetes mellitus undergoing cataract surgery by phacoemulsification, with no intraoperative complications. Detailed ophthalmic evaluation including fundus examination was done in all cases, and DR staging was done. Optical coherence tomography and fundus fluorescein angiography were done in indicated cases. Fundus evaluation was done during the follow-up visits in 3 weeks, 3 months, and 6 months postsurgery and the tests were repeated if necessary. RESULTS In the current study, there was a statistically significant improvement in best-corrected visual acuity after cataract surgery compared to the preoperative value. From the 330 eyes we analyzed, there was a progression of DR in only 18 eyes (5.45%) following phacoemulsification. There was a statistically significant increase in central macular thickness (CMT) at 3 weeks postoperative (433.82 ± 137.572) compared to that of the preoperative CMT (295.98 ± 97.959). From the 22 eyes which showed a progression of diabetic maculopathy, 11 eyes had developed new-onset macular edema following the cataract surgery, 11 eyes had progression of preexisting edema, and 4 of them had to undergo intravitreal anti-vascular endothelial growth factor injections as the treatment. CONCLUSION The chance of progression of DR staging is low after uncomplicated phacoemulsification, on a short term. However, the chances of worsening of macular edema as well as worsening of proliferative stages should be kept in mind while advising a patient for cataract surgery.
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Affiliation(s)
- R. Sruthi
- Department of Cataract and Glaucoma, Giridhar Eye Institute, Cochin, Kerala, India
| | - Seshadri J. Saikumar
- Department of Cataract and Glaucoma, Giridhar Eye Institute, Cochin, Kerala, India
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Gabrielle PH, Mehta H, Barthelmes D, Daien V, Nguyen V, Gillies MC, Creuzot-Garcher CP. From randomised controlled trials to real-world data: Clinical evidence to guide management of diabetic macular oedema. Prog Retin Eye Res 2023; 97:101219. [PMID: 37898362 DOI: 10.1016/j.preteyeres.2023.101219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023]
Abstract
Randomised clinical trials (RCTs) are generally considered the gold-standard for providing scientific evidence for treatments' effectiveness and safety but their findings may not always be generalisable to the broader population treated in routine clinical practice. RCTs include highly selected patient populations that fit specific inclusion and exclusion criteria. Although they may have a lower level of certainty than RCTs on the evidence hierarchy, real-world data (RWD), such as observational studies, registries and databases, provide real-world evidence (RWE) that can complement RCTs. For example, RWE may help satisfy requirements for a new indication of an already approved drug and help us better understand long-term treatment effectiveness, safety and patterns of use in clinical practice. Many countries have set up registries, observational studies and databases containing information on patients with retinal diseases, such as diabetic macular oedema (DMO). These DMO RWD have produced significant clinical evidence in the past decade that has changed the management of DMO. RWD and medico-administrative databases are a useful resource to identify low frequency safety signals. They often have long-term follow-up with a large number of patients and minimal exclusion criteria. We will discuss improvements in healthcare information exchange technologies, such as blockchain technology and FHIR (Fast Healthcare Interoperability Resources), which will connect and extend databases already available. These registries can be linked with existing or emerging retinal imaging modalities using artificial intelligence to aid diagnosis, treatment decisions and provide prognostic information. The results of RCTs and RWE are combined to provide evidence-based guidelines.
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Affiliation(s)
- Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, Dijon, Burgundy, France; The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Hemal Mehta
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Vincent Daien
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Montpellier University Hospital, Montpellier, France; Institute for Neurosciences of Montpellier, Univ Montpellier, INSERM, Montpellier, France
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Spinetta R, Petrillo F, Reibaldi M, Tortori A, Mazzoni M, Metrangolo C, Gelormini F, Ricardi F, Giordano A. Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus. Pharmaceutics 2023; 15:2461. [PMID: 37896220 PMCID: PMC10610055 DOI: 10.3390/pharmaceutics15102461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic macular edema (DME)'s therapeutic approach can frequently be challenging. The purpose of the review is to propose evidence-based recommendations on the employment of intravitreal dexamethasone implants (DEX) when approaching patients suffering from DME. Seven national consensuses redacted by different groups of retina specialists from Europe and Asia were examined and confronted. Each consensus was redacted utilizing a Delphi approach, in person meetings, or by reviewing the literature. DEX can be studied as a first-line strategy in individuals suffering from DME with inflammatory OCT biomarkers, in vitrectomized eyes, in patients with recent cardiovascular events, in pregnant women, in patients scheduled to undergo cataract surgery or with poor compliance. The other parameters considered were the indications to the DME treatment, when to switch to DEX, the definition of non-responder to anti-VEGFs agents and to the DEX implant, whether to combine DEX with laser photocoagulation, the association between glaucoma and DEX, and the management of DEX and the cataract. Although several years have passed since the introduction of DEX implants in the DME treatment, there is still not a unified agreement among retina specialists. This paper compares the approach in the DME treatment between countries from different continents and provides a broader and worldwide perspective of the topic.
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Affiliation(s)
| | - Francesco Petrillo
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Michele Reibaldi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Maria Mazzoni
- University Center for Studies on Gender Medicine, University of Ferrara, 44124 Ferrara, Italy;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Cristian Metrangolo
- Ophthalmology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy;
| | - Francesco Gelormini
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Federico Ricardi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
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Nourinia R, Kiani A, Hassanpour K, Nikkhah H, Faramarzi A, Emamverdi M. Optical coherence tomography angiography parameters after cataract surgery. Int Ophthalmol 2023; 43:2679-2686. [PMID: 36867381 DOI: 10.1007/s10792-023-02667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To evaluate the changes in macular blood flow after cataract surgery through optical coherence tomography angiography (OCT-A). METHODS In this prospective case series, 50 patients who underwent uncomplicated cataract surgery by the resident were included. OCT-A images and complete ocular examinations were performed at baseline, 1 and 3 months postoperatively. The changes in OCT-A parameters including foveal avascular zone (FAZ) area, vessel density (VD) of superficial and deep plexus, and central macular thickness were assessed before and after surgery. Cataract grading, intraocular inflammation, and duration of surgery were analyzed. RESULTS FAZ was significantly reduced from 0.36 ± 0.13 mm2 at baseline to 0.32 ± 0.12 mm2 at month 1 (P < 0.001) and this reduction continued until month 3. In the superficial layer, vessel density of the fovea, parafovea, and whole image significantly increased from 13.9 ± 6.8, 43.7 ± 4.7, and 43.2 ± 4.4 at baseline to 18.4 ± 7.9, 45.7 ± 4.9, and 44.9 ± 4.5 at month 1. The increase in the vessel density of the deep layer was similar to the superficial layer. Accordingly, CMT at the fovea was significantly increased from 240.5 ± 21.99 µm at baseline to 253.1 ± 23.2 microns at month 1 (P < 0.001) and the increase significantly continued and reached 259.5 ± 22.6 µm at month 3 (P < 0.001). Accordingly, the FAZ area significantly reduced one month postoperatively. In regression analysis, CMT changes positively correlated with cataract grading. FAZ area negatively correlated with intraocular inflammation on the first postoperative day. CONCLUSION The present study shows that CMT and vessel density of the macula significantly increase after uncomplicated cataract surgery, while the FAZ area reduces. Postoperative inflammation could be the possible explanation for the findings of this study.
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Affiliation(s)
- Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kiani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran
- Department of Ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Faramarzi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran
| | - Mehdi Emamverdi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Paidarfard St., Boostan 9 St., Pasdaran, Tehran, 16666, Iran.
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Liu J, Li R, Han K, Yu X, Tang Y, Zhao H. Intravitreal injection of Conbercept combined with micropulse laser therapy enhances clinical efficacy in patients with diabetic macular edema. Am J Transl Res 2023; 15:531-538. [PMID: 36777842 PMCID: PMC9908468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE To analyze the clinical efficacy of intravitreal injection of Conbercept (IVC) combined with micropulse laser (MPL) therapy in the treatment of diabetic macular edema (DME). METHODS In this retrospective study, we selected 64 DME patients who visited the First People's Hospital of Yunnan Province between February 2019 and February 2021 for analysis. Based on different intervention methods, 31 cases treated with IVC were included as a control group (the Con group) and 33 cases with IVC + MPL combination therapy were in a research group (the Res group). Data on curative effects, injection frequency, pre- and post-treatment best corrected visual acuity (BCVA) and central macular thickness (CMT), visual field gray value, 30° visual field average light threshold sensitivity, and mean visual field defect (VFD) were collected for inter-group comparisons. Further, Cox multivariate regression analysis was performed to identify factors affecting the curative efficacy of DME patients. RESULTS Compared with the Con group, the Res group had a higher total response rate and a lower injection frequency. In addition, higher BCVA and lower CMT were determined in the Res after 6 months of treatment. Moreover, Res group exhibited statistically lower visual field gray value and mean VFD, as well as higher 30° visual field average light threshold sensitivity than the Con at 1 month postoperatively. All the above differences were statistically significant. According to the Cox multivariate regression analysis, treatment modality was the influencing factor for the efficacy of DME patients. CONCLUSIONS IVC + MPL have better clinical efficacy than IVC alone for DME. The combined modality can improve patients' visual quality, inhibit DME, and reduce medication frequency.
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Affiliation(s)
- Jun Liu
- Department of Ophthalmology, The First People’s Hospital of Yunnan ProvinceKunming 650100, Yunnan, P. R. China,Department of Ophthalmology, Affiliated Hospital of Kunming University of TechnologyKunming 650032, Yunnan, P. R. China
| | - Rui Li
- Dehong Hospital of Traditional Chinese MedicineLuxi 678400, Yunnan, P. R. China
| | - Kunping Han
- Department of Ophthalmology, The First People’s Hospital of Yunnan ProvinceKunming 650100, Yunnan, P. R. China,Department of Ophthalmology, Affiliated Hospital of Kunming University of TechnologyKunming 650032, Yunnan, P. R. China
| | - Xiang Yu
- Kunming Sikang EyeClinicKunming 650032, Yunnan, P. R. China
| | - Yi Tang
- Department of Ophthalmology, The First People’s Hospital of Yunnan ProvinceKunming 650100, Yunnan, P. R. China,Department of Ophthalmology, Affiliated Hospital of Kunming University of TechnologyKunming 650032, Yunnan, P. R. China
| | - Haiyan Zhao
- Department of Ophthalmology, The First People’s Hospital of Yunnan ProvinceKunming 650100, Yunnan, P. R. China,Department of Ophthalmology, Affiliated Hospital of Kunming University of TechnologyKunming 650032, Yunnan, P. R. China
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Furino C, Niro A, Reibaldi M, Boscia F, Alessio G. Dexamethasone intravitreal implant along with femtosecond laser assisted cataract surgery in patients with diabetic macular edema and cataract. Eur J Ophthalmol 2022; 33:1425-1433. [PMID: 36567493 DOI: 10.1177/11206721221146328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the safety and efficacy of intraoperative dexamethasone intravitreal (DEX) implant in patients with diabetic macular edema (DME) undergoing femtosecond laser assisted cataract surgery (FLACS). METHODS In this single-center retrospective study, the charts of patients who underwent combined FLACS and DEX implant in the previous three months were reviewed. Primary outcome measures were ocular complications; secondary outcome measures were the change of best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS 20 eyes of 20 patients were included. None developed intraoperative or postoperative complications. Mean BCVA was 20/120 (logMAR, 0.78 ± 0.31) at baseline and improved significantly to 20/63 (logMAR, 0.52 ± 0.24; p = 0.01), 20/58 (LogMAR, 0.48 ± 0.28; p < 0.001) and to 20/58 (LogMAR, 0.48 ± 0.31; p < 0.001) at month 1,2 and 3, respectively. A mean improvement of 0.30 LogMAR was recorded at month 1 and 3. Mean CRT decreased significantly from 416.6 ± 76.1 μm at baseline to 322.4 ± 46.4 μm (p < 0.001), to 300.7 ± 29.7 μm (p < 0.001), and to 319.8 ± 54.7 μm (p < 0.001) at month 1,2 and 3, respectively. Comparing to the 1-month follow-up, the largest mean reduction in CRT (112.4 ± 68.9 µm) was observed at month 2 (p = 0.001). Fourteen patients (70%) had an improvement of CRT over the first 2 months followed by a recurrence of edema at month 3. CONCLUSION DEX implant following FLACS seems to be a safe and effective approach for patients with coexisting cataract and DME.
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Affiliation(s)
- Claudio Furino
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. ANNUNZIATA", 170130ASL TA, Taranto, Italy
| | | | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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Yen CY, Yen JC, Chen CC, Hu HY, Cheng FS, Tseng PC. Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study. Medicine (Baltimore) 2022; 101:e30115. [PMID: 35984152 PMCID: PMC9387960 DOI: 10.1097/md.0000000000030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to investigate the therapeutic effect of cataract surgery along with simultaneous intravitreal injection (IVI) of aflibercept on diabetic macular edema (DME). This cohort study enrolled 106 patients aged >40 years with type 2 diabetes mellitus and DME who received cataract surgery from January 1, 2016, to October 31, 2020. The baseline and mean data of the following parameters were collected: age, sex, glycated hemoglobin level, diabetic retinopathy (DR) grading, previous DR treatments including IVI of anti-vascular endothelial growth factor and pan-retinal photocoagulation, intraocular pressure, use of intraocular pressure-lowering medication, central subfield thickness (CST), and log MAR visual acuity (VA). Patients were categorized into 2 groups based on whether they received aflibercept IVI or not during cataract surgery and were compared using the t test and Fisher exact test for continuous and discrete variables, respectively. Beta coefficient and standard error were calculated using multiple linear regression analysis to identify the explanatory variables predictive of the net change of CST and log MAR VA. There was no difference in the net change in CST (15.24 ± 45.07 μm vs 18.62 ± 33.84 μm, P = .772) and log MAR VA (-0.27 ± 0.29 vs -0.37 ± 0.31, P = .215). Gender, glycated hemoglobin level, aflibercept IVI during cataract surgery, and baseline CST did not interfere with the morphological and functional outcomes of DME in cataract surgery. Older age was significantly and independently associated with a greater net change in log MAR VA. Proliferative DR was significantly and independently associated with a greater net change in CST and log MAR VA. A greater baseline log MAR VA was significantly and independently associated with lower net change in log MAR VA. Simultaneous aflibercept IVI for treating DME may not interfere with the functional and tomographic parameters of cataract surgery relative to cataract surgery alone. Factors influencing the outcomes of patients with DME undergoing cataract surgery are as follows: age, baseline DR staging, and baseline VA. Identifying these factors of DME preoperatively may be an important consideration in preventing it from progressing and for improving the overall visual prognosis.
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Affiliation(s)
- Chu-Yu Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Ju-Chuan Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Chen Tseng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- *Correspondence: Po-Chen Tseng, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City 10629, Taiwan (e-mail: )
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Al Qassimi N, Kozak I, Al Karam M, Neri P, Aduriz-Lorenzo PM, Attawan A, Awadalla M, El Khashab A, Abdul-Nabi M, Safar A, Al Shamsi H, Rao P, Rao M, Farid A, Gurbaxani A. Management of Diabetic Macular Edema: Guidelines from the Emirates Society of Ophthalmology. Ophthalmol Ther 2022; 11:1937-1950. [PMID: 35896888 PMCID: PMC9437198 DOI: 10.1007/s40123-022-00547-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
In the United Arab Emirates, retinopathy has been shown to be present in 19% of the diabetic population, with diabetes identified in up to 40% of individuals aged over 55 years. Despite the prevalence of diabetic retinal diseases, there are no unified national guidelines on the management of diabetic macular edema (DME). These published guidelines are based on evidence taken from the literature and published trials of therapies, and consensus opinion of a representative expert panel with an interest in this condition, convened by the Emirates Society of Ophthalmology. The aim is to provide evidence-based, clinical guidance for the best management of different aspects of DME, with a special focus on vision-threatening diabetic retinopathy. Treatment should be initiated in patients with best-corrected visual acuity 20/30 or worse, and/or features of DME as seen on optical coherence tomography (OCT) with central retinal thickness (CRT) of at least 300 μm or in symptomatic patients with vision better than 20/25, and/or CRT less than 300 μm where there are OCT features consistent with center-involving macular edema. The treatment of DME is effective irrespective of glycated hemoglobin (HbA1c) level, and treatment must not be denied or delayed in order to optimize systemic parameters. All ophthalmic treatment options should be discussed with the patient for better compliance and expectations. Non-center-involving DME can be initially observed until progression toward the center is documented. Macular laser no longer has a primary role in center-involving DME, and anti-vascular endothelial growth factor (anti-VEGF) therapy should be considered as first-line treatment for all patients, unless contraindicated. If anti-VEGF is contraindicated, a steroid dexamethasone implant can be considered for first-line treatment. Recommendations for the treatment of DME in special circumstances and in relapsing and refractory DME are also discussed.
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Affiliation(s)
| | - Igor Kozak
- Moorfields Eye Hospital, Abu Dhabi, United Arab Emirates
| | | | - Piergiorgio Neri
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | | | | | - Mohamed Abdul-Nabi
- Sheikh Shakhbout Medical City in Association With Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Ammar Safar
- Moorfields Eye Hospital, Dubai, United Arab Emirates
| | | | - Prasan Rao
- Medcare Eye Centre, Dubai, United Arab Emirates
| | - Madhav Rao
- Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Amr Farid
- Magrabi Eye Hospital, Dubai, United Arab Emirates
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11
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Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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12
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Vadalà M, Trapani VS, Amato M, Bongiovanni G, Alaimo F, Cillino S, Bonfiglio VME. Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study. Eur J Ophthalmol 2021; 32:2760-2770. [PMID: 34878320 DOI: 10.1177/11206721211062037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of preoperative intravitreal dexamethasone implant (DexI) on functional and anatomic outcomes in patients with diabetic macular edema (DME) who underwent phacoemulsification cataract surgery. METHODS Prospective and non-comparative study conducted on consecutive DME patients undergoing cataract surgery. DexI was administered 15 days before surgery and in a pro re nata regime after surgery. Main outcome measures were mean change in central retinal thickness (CRT), central subfield thickness (CST), total macular volume (TMV), and central subfield volume (CSV) from baseline to month-12. Secondary outcome was mean change in best corrected visual acuity (BCVA). RESULTS Forty eyes were included in the study. CRT significantly decreased from 410.4 ± 64.8 µm at baseline to 303.2 ± 24.3 µm at month-12, p < 0.0001. Similarly, CST was significantly reduced from 436.4 ± 120.4 µm at baseline to 322.9 ± 54.2 µm at month-12, p < 0.0001. Total macular volume and CSV were significantly reduced from 9.95 ± 1.68 mm3 and 0.38 ± 0.11 mm3 at baseline to 8.49 ± 0.83 mm3 and 0.31 ± 0.05 mm3 at month-12, respectively (p < 0.0001 each, respectively). BCVA significantly improved from 0.26 ± 0.17 Snellen equivalent at baseline to 0.65 ± 0.19 at month-12, p < 0.0001. Mean DexI administered during the study were 2.0 ± 0.3. Neither DME subtype nor previous treatment status had any effect on functional or anatomic outcomes. Regarding safety, one (2.5%) eye developed ocular hypertension, which was successfully controlled with topical hypotensive treatment. CONCLUSIONS DexI was and effective and safe strategy for managing DME in diabetic patients undergoing uneventful cataract surgery.
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Affiliation(s)
- Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy.,IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | | | - Mario Amato
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Giuseppe Bongiovanni
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Francesco Alaimo
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Salvatore Cillino
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
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13
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Starr MR, Mahr MA, Smith WM, Iezzi R, Barkmeier AJ, Bakri SJ. Outcomes of Patients With Active Diabetic Macular Edema at the Time of Cataract Surgery Managed With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Am J Ophthalmol 2021; 229:194-199. [PMID: 33852907 DOI: 10.1016/j.ajo.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the outcomes of cataract surgery in patients with active diabetic macular edema (DME) who are receiving active treatment with intravitreal anti-vascular endothelial growth factor (VEGF) injections in the perioperative period. DESIGN Retrospective clinical cohort study. METHODS We reviewed all patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1, 2012 through December 31, 2017. Thirty-seven eyes underwent cataract surgery and received ≥1 intravitreal anti-VEGF injection for a diagnosis of DME within 6 months before surgery. Outcome measures included the development of subretinal or intraretinal fluid in the 6 months after surgery, timing of injections, number of injections, best-corrected visual acuity, and central subfield thickness. RESULTS There was a significant improvement between pre- and postoperative best-corrected visual acuity when comparing all eyes (Ps < .0001) and no significant difference in central subfield thickness before and after surgery (P > .05). There were 30 eyes (81.1%) that had fluid on the preoperative optical coherence tomography scan. Seventeen eyes (45.9%) developed new or worsening postoperative DME. Comparing the eyes that did or did not develop worsening DME, there were no differences in postoperative visual acuities (P > .05). Eyes that did develop new fluid had significant increases in postoperative central subfield thickness at both 1 month (350 vs 320 μm, P = .036) and 6 months (342 vs 305 μm, P = .013). CONCLUSION In a real-world setting, patients with cataracts and actively treated DME may undergo cataract surgery but may see a worsening of DME not immediately affecting the best-corrected visual acuity.
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Affiliation(s)
- Matthew R Starr
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Mahr
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendy M Smith
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymond Iezzi
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew J Barkmeier
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sophie J Bakri
- From the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Panozzo G, Mura GD, Franzolin E, Giannarelli D, Albano V, Alessio G, Arrigo A, Casati S, Cassottana P, Contardi C, D'Aloisio R, Fasce F, Gusson E, Marchini G, Mastropasqua L, Niccolò M, Palmisano C, Pastore MR, Saviano S, Tognetto D, Bandello F. Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study. Eye (Lond) 2021; 36:1687-1693. [PMID: 34345028 PMCID: PMC8330474 DOI: 10.1038/s41433-021-01718-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). METHODS DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. RESULTS The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (-2.6 ± 3.5 letters vs -8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups. CONCLUSION Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.
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Affiliation(s)
- Giacomo Panozzo
- Ophthalmology Unit, Clinica San Francesco, Verona, Italy. .,ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland.
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Elia Franzolin
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Diana Giannarelli
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Valeria Albano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Gianni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Casati
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Paola Cassottana
- Department of Ophthalmology, San Martino University Hospital, IRCCS, Genova, Italy
| | - Cecilia Contardi
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rossella D'Aloisio
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Fasce
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Gusson
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Leonardo Mastropasqua
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Massimo Niccolò
- Department of Ophthalmology, University of Genova, Genova, Italy
| | - Carmela Palmisano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Marco Rocco Pastore
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Sandro Saviano
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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15
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Song W, Conti TF, Gans R, Conti FF, Silva FQ, Saroj N, Singh RP. Prevention of Macular Edema in Patients With Diabetic Retinopathy Undergoing Cataract Surgery: The PROMISE Trial. Ophthalmic Surg Lasers Imaging Retina 2021; 51:170-178. [PMID: 32211907 DOI: 10.3928/23258160-20200228-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the safety and efficacy of intravitreal aflibercept injection (IAI) in patients with diabetic retinopathy (DR) in the prevention of macular edema (ME) following cataract surgery. PATIENTS AND METHODS This phase 2, prospective, interventional, single-masked, randomized trial at a single academic center included 30 patients who were 18 years of age or older with nonproliferative DR and undergoing cataract surgery with phacoemulsification. Patients received 2 mg intravitreal aflibercept (0.05 mL) or sham injection during cataract surgery. Main outcome measures included treatment adverse events (AEs), best-corrected visual acuity (BCVA), and incidence of ME (defined as presence of cystoid abnormalities as detected by optical coherence tomography at any follow-up visit), a 30% or greater increase from preoperative baseline in central subfield macular thickness, or a BCVA decrease of more than 5 ETDRS letters from Day 7 due to retinal thickening. RESULTS There were similar incidences of AEs between the two groups and no clinically serious ocular AEs in either group. The IAI group had fewer ME events at Day 14 (13% vs. 53%; P = .022), but there was no significant difference in ME events at Day 30 (27% vs. 60%; P = .057), Day 60 (27% vs. 60%; P = .057), or Day 90 (40% vs. 67%; P = .161). Compared to the study group, the control group had a significantly greater increase in central subfield thickness (CST) at Day 30 (50.05 μm vs. 7.95 μm; P = .040) and Day 60 (56.45 μm vs. 3.02 μm; P = .010). However, the difference in CST between groups was no longer significant at Day 90 (50.31 μm vs. 18.48 μm; P = .12). There were no significant differences in BCVA gains between the IAI and sham group at the end of the follow-up period (Day 90, ETDRS letters: 9.88 vs. 8.52; P = .66). CONCLUSIONS Use of IAI in patients with DR for prevention of ME following cataract surgery showed no significant AEs. Although there were significant differences in ME incidence and retinal thickness at periods of time, there was no clinically meaningful benefit in terms of VA. Further larger trials are needed to validate these findings. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:170-178.].
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16
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Macular Vascular Density Changes following Cataract Surgery in Diabetic Patients: An Optical Coherence Tomography Angiography Study. J Ophthalmol 2021; 2021:6641944. [PMID: 33854796 PMCID: PMC8019390 DOI: 10.1155/2021/6641944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/21/2021] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Cataracts and diabetes very commonly coexist. The aim of the present study was to quantify the effect of uncomplicated phacoemulsification on retinal microvasculature in diabetic patients by using optical coherence tomography angiography (OCTA). Methods A prospective observational study of diabetic and nondiabetic patients at baseline and 1 day, 1 week, 1 month, and 3 months after cataract surgery was performed by using OCTA. We measured the macular thickness (MT), superficial capillary plexus (SCP), deep capillary plexuses (DCP), and foveal avascular zone (FAZ) in the 3 × 3 mm macular images. Results A total of 32 eyes of 32 type 2 diabetic patients and 40 eyes of 40 nondiabetic patients were assessed. There was a significant increase in MT at 1 month and 3 months after surgery in both groups (all P < 0.05), but there was no significant difference between the two groups (P=0.217). At 3 months postoperatively, the SCP level in the diabetic group was significantly higher than that at baseline (P < 0.05). The MT and SCP were negatively correlated with logMAR best-corrected visual acuity (BCVA), while the FAZ area and perimeter were positively correlated with logMAR BCVA in the diabetic group. Conclusions Our study demonstrated that phacoemulsification can increase macular thickness in both diabetic and nondiabetic patients and increase SCP in diabetic patients within 3 months after surgery. Whether these changes persist for a longer period still needs to be investigated.
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17
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Barone A, Russo V, Maggiore G, Loiodice MS, Stella A, Bux AV, Iaculli C. Dexamethasone intravitreal implant in patients with cataract and naïve diabetic macular edema. Eur J Ophthalmol 2021; 32:364-371. [PMID: 33757366 DOI: 10.1177/11206721211004395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess the feasibility and clinical effectiveness of dexamethasone intravitreal implant 0.7 mg (IDI) administered in diabetic patients to prevent the worsening of macular edema. METHODS Forty eyes of 40 consecutive patients with naïve macular edema secondary to diabetes mellitus who were treated with IDI administered preoperative (Group A: 20 patients) or IDI administered immediately after cataract surgery (Group B: 20 patients). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes were evaluated at baseline and at postoperative time points. RESULTS Follow-up study was 20 weeks. In Group A and B, mean BCVA improved significantly at all post-surgery time points (p < 0.05). In Group A and B, mean CMT decreased significantly at 16 weeks (p = 0.02 and p = 0.004, respectively). At week 20, CMT failed to reach statistical significance in both groups (p = 0.5, group A and p = 0.15, group B). No statistical differences were noted between groups in term of BCVA (with the exception of week 4 for the presence of cataract in Group A), CMT and IOP. CONCLUSIONS The use of intravitreal dexamethasone implant 1 month prior to scheduled cataract extraction or at the time of phacoemulsification appears to be safe and effective for at least 16 weeks after surgery.
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Affiliation(s)
- Antonio Barone
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Vincenzo Russo
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Giulia Maggiore
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | | | - Andrea Stella
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Anna Valeria Bux
- Department of Ophthalmology, University of Foggia, Foggia, Italy
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18
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Howaidy A, Eldaly ZH, Anis M, Othman TM. Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab. Eur J Ophthalmol 2021; 32:205-212. [PMID: 33726537 DOI: 10.1177/11206721211001275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. PATIENTS AND METHODS A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. RESULTS The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. CONCLUSION Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.
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Affiliation(s)
- Ahmed Howaidy
- Department of Ophthalmology, Aswan University, Sahary City, Egypt
| | - Zeiad H Eldaly
- Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt
| | - Mohamed Anis
- Department of Ophthalmology, Cairo University, Giza, Egypt
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19
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Intravitreal Therapy for Diabetic Macular Edema: An Update. J Ophthalmol 2021; 2021:6654168. [PMID: 33688431 PMCID: PMC7925023 DOI: 10.1155/2021/6654168] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic macular edema (DME) represents a prevalent and disabling eye condition. Despite that DME represents a sight-threatening condition, it is also among the most accessible to treatment. Many different treatment options including photocoagulation, intravitreal medical treatment (either vascular endothelial growth factor inhibitors or corticosteroids therapies), and surgical removal are currently available. Although laser has been considered as the gold standard for many years, over the past several years vascular endothelial growth factor inhibitors (anti-VEGFs) have become first-line therapy. However, many patients do not adequately respond to them. With the development of sustained-release corticosteroid devices, steroids have gained a presence in the management of the DME. We review and update the role of anti-VEGF and intravitreal sustained-release corticosteroid management of DME. According to the currently available scientific evidence, the choice of one anti-VEGF over another critically depends on the baseline best-corrected visual acuity (BCVA). While aflibercept may be the drug of choice in low baseline BCVA, the three anti-VEGFs (bevacizumab, ranibizumab, and aflibercept) provided similar functional outcomes when the baseline BCVA was higher. DEX implants are a valuable option for treating DME, although they are usually seen as a second choice, particularly in those eyes that have an insufficient response to anti-VEGF. The new evidence suggested that, in eyes that did not adequately respond to anti-VEGF, switching to a DEX implant at the time to 3 monthly anti-VEGF injections provided better functional outcomes.
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20
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Fallico M, Avitabile T, Castellino N, Longo A, Russo A, Bonfiglio V, Parisi F, Furino C, Panozzo G, Scorcia V, Carnevali A, Bandello F, Parodi MB, Cennamo G, Cillino S, Vadalà M, Sunseri Trapani V, Cagini C, Fiore T, Lupidi M, Parravano M, Varano M, Giorno P, Boscia F, Giancipoli E, Eandi C, Le Mer Y, Reibaldi M. Intravitreal dexamethasone implant one month before versus concomitant with cataract surgery in patients with diabetic macular oedema: the dexcat study. Acta Ophthalmol 2021; 99:e74-e80. [PMID: 32588978 DOI: 10.1111/aos.14516] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report clinical outcomes of two different timings of intravitreal dexamethasone (DEX) implant administration for prevention of diabetic macular oedema (DME) worsening following cataract surgery. METHODS This multicentre, retrospective study included patients with DME who received an intravitreal DEX implant 1 month before cataract surgery, 'precataract DEX' group, or at the time of cataract surgery, 'concomitant treatments' group. Inclusion criteria were a follow-up ≥3 months and ophthalmological examination with optical coherence tomography (OCT) imaging at baseline (cataract surgery) and throughout follow-up. Anatomical improvement was considered to be a decrease in OCT central subfield (CSF) thickness ≥20% compared to baseline. The primary outcomes were anatomical and functional results at 3 months. RESULTS Two hundred twenty-one patients were included: 136 in the 'precataract DEX' group and 85 in the 'concomitant treatments' group. At 3 months, a reduction of CSF thickness ≥ 20% was found in 7.3% of eyes in the 'precataract DEX group' and in 83.7% of eyes in the 'concomitant treatments' group (p < 0.001), with mean CSF thickness lower in the latter group (371 ± 52 µm versus 325 ± 57 µm, p < 0.001). At 3 months, mean best-corrected visual acuity had improved from baseline in both groups (p < 0.001), with no difference between groups (p = 0. 20). No serious systemic adverse events were reported. CONCLUSION Both approaches prevented a worsening of DME, showing a comparable visual outcome. Dexamethasone (DEX) implant given at the same time as cataract surgery provided a better anatomical outcome.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
- Eye Unit Southampton University Hospital Southampton UK
| | | | | | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | | | - Claudio Furino
- Department of Ophthalmology University of Bari Bari Italy
| | - Giacomo Panozzo
- Ophthalmology Unit Bussolengo Hospital Bussolengo Verona Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Adriano Carnevali
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Francesco Bandello
- Department of Ophthalmology University Vita‐Salute Hospital San Raffaele Milano Italy
| | | | - Gilda Cennamo
- Department of Public Health University of Naples Federico II Naples Italy
| | - Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Valentina Sunseri Trapani
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Carlo Cagini
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Tito Fiore
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Marco Lupidi
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | | | - Monica Varano
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | - Paola Giorno
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | | | | | - Chiara Eandi
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Michele Reibaldi
- Department of Ophthalmology University of Catania Catania Italy
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
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Ma LY, Rong A, Jiang Y, Deng SY. Effects of Femtosecond Laser-Assisted Cataract Surgery on Macular and Choroidal Thickness in Diabetic Patients. Ophthalmol Ther 2021; 10:137-150. [PMID: 33464557 PMCID: PMC7887143 DOI: 10.1007/s40123-020-00326-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction This study aimed to compare the short-term changes in retinal and choroid thickness in diabetic patients after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (PE) surgery. Methods A total of 47 eyes in the PE group and 44 eyes in the FLACS group were included. All patients underwent measurement of central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) before and after surgery using optical coherence tomography (OCT). Results The effective phaco time (EPT) in the FLACS group was significantly reduced. The BCVA differed significantly between the two groups at 1 week and 1 month after surgery. The CMT in both groups increased at 1 week after the operation. It did not return to the preoperative level until month 12 in the PE group. In the FLACS group, the CMT began to decrease at month 3 and recovered to the preoperative level at month 12. The SFCT of the two groups increased at week 1; it began to decrease at month 6 in the PE group but did not recover to the preoperative level until month 12. The SFCT in the FLACS group recovered to preoperative levels at month 6. In the PE group, baseline CMT values predicted CMT change at week 1 and months 1, 3 and 12 after surgery. In the FLACS group, baseline CMT predicted CMT changes at week 1, month 1 and month 3. In the FLACS group, EPT predicted SFCT change at month 3. Conclusion FLACS is safe and effective in patients with no fundus change or mild diabetic retinopathy. It has advantages in effectively reducing EPT, achieving good vision earlier and promoting faster recovery of the retinal and choroidal thickness. Preoperative CMT is a significant predictor of CMT changes in the early period after FLACS.
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Affiliation(s)
- Ling-Yun Ma
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China. .,Shanghai Xin Shi Jie Eye Hospital, Shanghai, 200050, China.
| | - Yi Jiang
- Shanghai Xin Shi Jie Eye Hospital, Shanghai, 200050, China
| | - Shu-Ya Deng
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China
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Das T, Behera UC, Bhattacharjee H, Gilbert C, Murthy GVS, Rajalakshmi R, Pant HB, Shukla R. Spectrum of eye disorders in diabetes (SPEED) in India: Eye care facility based study. Report # 1. Eye disorders in people with type 2 diabetes mellitus. Indian J Ophthalmol 2020; 68:S16-S20. [PMID: 31937723 PMCID: PMC7001179 DOI: 10.4103/ijo.ijo_33_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose To document the spectrum of eye diseases in people with type 2 diabetes mellitus (T2DM) reporting to large eye care facilities in India. Methods The selection of eye care facilities was based on the zone of the country and robustness of the programs. Only people with known T2DM certified by internist, or taking antidiabetes medications, or referred for diabetes related eye diseases were recruited. The analysis included the demographic characteristics, systemic associations, ocular comorbidities, and visual status. Results People (11,182) with T2DM were recruited in 14 eye care facilities (3 in north, 2 in south central, 4 in south, 2 in west, and 3 in east zone); two were government and 12 were non-government facilities. Hypertension was the commonest systemic association (n = 5500; 49.2%). Diabetic retinopathy (n = 3611; 32.3%) and lens opacities (n = 6407; 57.3%) were the common ocular disorders. One-fifth of eyes (n = 2077; 20.4%) were pseudophakic; 547 (5.4%) eyes had glaucoma and 277 (2.5%) eyes had retinal vascular occlusion. At presentation, 4.5% (n = 502) were blind (visual acuity < 3/60 in the better eye) and 9.6% (n = 1077) had moderate to severe visual impairment (visual acuity <6/18-->3/60 in the better eye). Conclusion People with T2DM presenting at eye clinics in India have high rates of diabetic retinopathy and vision loss. Cataract is a very common occurrence. Advocacy, infrastructure strengthening, and human resource development are the key to address the growing threats of T2DM and eye care in India.
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Affiliation(s)
- Taraprasad Das
- Srimati Kanuri Santamma Centre for Vitreoretinal diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Umesh C Behera
- Department of Retina and Vitreous, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Clare Gilbert
- London School of Hygiene and Tropical Medicine, London, UK
| | - G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, India
| | - Ramachandran Rajalakshmi
- Department of Ophthalmology, Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Hira B Pant
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, India
| | - Rajan Shukla
- Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, India
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PREOPERATIVE VITREORETINAL INTERFACE ABNORMALITIES ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AS RISK FACTOR FOR PSEUDOPHAKIC CYSTOID MACULAR EDEMA AFTER PHACOEMULSIFICATION. Retina 2020; 39:2225-2232. [PMID: 30157113 DOI: 10.1097/iae.0000000000002298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the role of vitreoretinal interface status in the development of pseudophakic cystoid macular edema (PCME) after cataract surgery. METHODS Prospective cohort study in which 112 patients (112 eyes) scheduled for cataract surgery were selected at random to undergo spectral domain optical coherence tomography (OCT) within 1 week preoperatively and at 1 and 3 months postoperatively. Spectral domain OCT macular images included no vitreoretinal contact, focal and diffuse vitreomacular adhesion, focal and diffuse vitreomacular traction, epiretinal membrane, macular hole, and macular edema. RESULTS The incidence of PCME was 11.6% (13 eyes), all of them being diagnosed at 1 month, and 7 eyes resolved at 3 months. The only risk factor for PCME was detection of nonsurgical epiretinal membrane by spectral domain OCT before phacoemulsification, being developed in 5 of 16 eyes (χ = 0.08, odds ratio 4.53, 95% confidence interval 1.28-16.13). Other variables such as posterior vitreous detachment, subfoveal choroidal thickness, diabetes, or hypertension were not significantly associated with PCME. CONCLUSION In this cohort, preoperative detection of epiretinal membrane by spectral domain OCT was a risk factor for PCME after cataract extraction. It is recommended to perform a spectral domain OCT before cataract surgery because the presence of an epiretinal membrane may be passed unnoticed by fundus examination.
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Minnella AM, Maceroni M, Picardi SM, Placidi G, De Siena E, Rizzo S, Falsini B. Combined Intravitreal Dexamethasone Implant and Cataract Surgery in Patients with Diabetic Retinopathy: Effect on Retinal Morphology and Function. Adv Ther 2020; 37:4675-4684. [PMID: 32970316 PMCID: PMC7547947 DOI: 10.1007/s12325-020-01506-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 01/30/2023]
Abstract
Introduction Cataract surgery can be associated with vision-threatening complications in patients with diabetes. This study aimed to assess the functional and anatomic outcomes of the intravitreal dexamethasone (DEX) implant, administered at the time as cataract surgery, in patients with diabetic retinopathy and diabetic macular edema (DME). Methods This was a retrospective, observational, and single-center study. The primary endpoint was the mean change in central macular thickness (CMT) from baseline to month 1. Secondary endpoints included mean change in best corrected visual acuity (BCVA) from baseline to month 1 and 3, mean change in CMT from baseline to month 3, the photopic negative response (PhNR) and the b wave of flash full-field electroretinogram from baseline to month 1, and the incidence of adverse events. Results Twenty-four eyes of 21 patients were included in the study. The mean (range) age of patients was 69 (63–87) years and 13 (61.9%) were men. Mean (standard deviation) CMT significantly decreased from 447 (134) µm at baseline to 341 (134) µm at month 1 (mean difference − 106 ± 134 µm, 95% CI − 183.9 to − 28.1 µm; p = 0.0087). BCVA significantly improved from 46 (20) ETDRS letters at baseline to 59 (22) ETDRS letters at month 1 (mean difference 13 ± 21 letters, 95% CI 0.8–25.2 letters; p = 0.0375). Regarding electrophysiology, there was a statistically significant reduction in mean PhNR from 5.24 (1.67) µV at baseline to 3.73 (1.19) µV at month 1 (mean difference − 1.51 ± 0.42 µV, 95% CI − 2.4 to − 0.7 µV, p = 0.0008); whereas b wave amplitude did not change (12.69 ± 6.89 µV at baseline versus 12.29 ± 6.30 µV at month 1; p = 0.8347). Four (16.7%) eyes developed ocular hypertension over the course of follow-up, which was successfully controlled with topical hypotensive medication. Conclusion Perioperative DEX implant significantly improved both anatomic and functional outcomes in patients with DME who underwent cataract surgery.
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Jo YC, Yeom MI, Kim SS. Delayed Symptoms after Intralenticular Dexamethasone Implant. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.9.1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY: A Meta-Analysis. Retina 2020; 39:1720-1731. [PMID: 29975344 DOI: 10.1097/iae.0000000000002221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR). METHODS Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom). RESULTS Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively). CONCLUSION Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample-sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.
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Alessio G, Boscia F, Caporossi A, Panozzo G, Reibaldi M, Staurenghi G, Varano M, Bandello F. Dexamethasone implants in patients with diabetic macular edema undergoing cataract surgery: Italian expert panel consensus statements. Eur J Ophthalmol 2020; 31:1122-1127. [PMID: 32635762 DOI: 10.1177/1120672120939500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Intravitreal corticosteroid implants based on sustained-release dexamethasone provide effective retinal delivery of drug for around 6 months for the treatment of diabetic macular edema (DME). As current recommendations on the management of patients with DME undergoing cataract surgery are limited, this article aims to highlight issues and provide guidance on the use of dexamethasone intravitreal implants (DEX-DDS) in patients with DME undergoing cataract surgery, based on the consensus findings of a panel of Italian experts. METHODS The panel developed a survey regarding the use of DEX-DDS in patients with DME undergoing cataract surgery, following a comprehensive literature search. The results of the survey were discussed at an experts' meeting in September 2018, with a structured approach to determining consensus. The routine management of patients with DME undergoing cataract surgery was also developed for use as a basis of discussion to highlight current issues. RESULTS Eight consensus statements are presented, along with key issues that highlight controversial/outstanding issues in the use of DEX-DDS in DME patients with cataracts. CONCLUSION The consensus statements can help provide practical guidance for clinicians in daily practice on the rationale, patient diagnosis and selection, and optimal management of patients with DME undergoing cataract surgery.
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Affiliation(s)
- Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari "A. Moro", Bari, Italy
| | - Francesco Boscia
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Aldo Caporossi
- Fondazione Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Lazio, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Sacco Hospital, University of Milan, Milan, Italy
| | | | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Leung EH, Gibbons A, Koch DD. Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens. Ophthalmology 2020; 127:859-865. [PMID: 32173111 PMCID: PMC7311225 DOI: 10.1016/j.ophtha.2020.01.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation. DESIGN Cost-effectiveness analysis. PARTICIPANTS A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery. METHODS The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs). RESULTS Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios. CONCLUSIONS A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.
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Affiliation(s)
- Ella H Leung
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
| | - Allister Gibbons
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Douglas D Koch
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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29
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Perioperative Management of Diabetic Macular Edema. Int Ophthalmol Clin 2020; 60:41-50. [PMID: 32576722 DOI: 10.1097/iio.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rossi T, Panozzo G, Della Mura G, Giannarelli D, Ferrari D, Alessio G, Palmisano C, Telani S, Ripandelli G. Diabetes and diabetic retinopathy in patients undergoing cataract surgery: a prevalence study-DiCat study report #2. Acta Diabetol 2020; 57:645-650. [PMID: 31912329 DOI: 10.1007/s00592-019-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To report on the prevalence of diabetes, diabetic macula oedema (DME) and retinopathy and their respective grading in a large cohort of patients undergoing cataract surgery. METHODS Data on previous diagnosis of diabetes, fasting glucose, glycated haemoglobin, presence and type of retinopathy and other maculopathy of 3657 patients over 55 years of age undergoing cataract surgery in 13 centres scattered throughout Italy were analysed. RESULTS A total of 20.4% of patients were known diabetics and 27.9% of diabetics showed signs of retinopathy. Haemoglobin A1C was higher than 48 mmol/L (6.5%) in 32% of diabetics and 2.4% non-diabetics. Fasting blood glucose level was higher than 120 mg/dL in 4.3% non-diabetics and 50% diabetics. Duration of diabetes did not significantly correlate with either fasting glucose or glycated haemoglobin, while higher grades of diabetic retinopathy were significantly more prevalent as duration of disease increased. DME was present in almost 40% of diabetics and 22% of patients showed non-diabetic maculopathy. DISCUSSION Diabetic retinopathy and DME worsen after cataract extraction thus complicating long-term prognosis and requiring expensive injective therapy. Since unknown diabetics represent 2-4% of the many million cataract candidates and even known diabetics show poor metabolic control and high rates of DME, preoperative medical testing and accurate retinopathy screening may prove both ethically necessary and cost-effective.
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Affiliation(s)
- Tommaso Rossi
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy.
| | - Giacomo Panozzo
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Giulia Della Mura
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Ferrari
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
| | | | | | - Serena Telani
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
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Tham YC, Liu L, Rim TH, Zhang L, Majithia S, Chee ML, Tan NYQ, Wong KH, Ting DSW, Sabanayagam C, Wang JJ, Mitchell P, Wong TY, Cheng CY. Association of Cataract Surgery With Risk of Diabetic Retinopathy Among Asian Participants in the Singapore Epidemiology of Eye Diseases Study. JAMA Netw Open 2020; 3:e208035. [PMID: 32543701 PMCID: PMC7298610 DOI: 10.1001/jamanetworkopen.2020.8035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Cataracts and diabetic retinopathy (DR) are the leading causes of acquired blindness worldwide. Although extraction is the standard treatment option for cataracts, it is also reported to increase the risk of developing DR among individuals with diabetes. Nevertheless, the association between cataract surgery and risk of DR is still not well understood, and there have been no prior population-based reports in this area. OBJECTIVE To assess the risk of developing DR after cataract surgery among individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS A population-based prospective cohort study was conducted among participants recruited from the Singapore Epidemiology of Eye Diseases Study. The baseline visit was conducted between June 1, 2004, and March 31, 2009, and the 6-year follow-up visit was conducted between June 1, 2011, and July 31, 2016. Statistical analysis was performed from October 1 to 31, 2019. EXPOSURES Cataract surgery performed before a follow-up visit, determined based on slitlamp evaluation of lens status at baseline and follow-up visits. MAIN OUTCOMES AND MEASURES Eyes with incidence of DR were defined as those with the presence of any DR (level ≥15 based on the modified Airlie House classification system, graded from retinal photographs) at 6-year follow-up with no DR at baseline. The association between cataract surgery and incidence of DR was evaluated using a multivariable Poisson regression model with a generalized estimating equation to account for correlation between both eyes. RESULTS A total of 1734 eyes from 972 participants with diabetes (392 Malay individuals and 580 Indian individuals; 495 men; mean [SD] age, 58.7 [9.1] years) were included in the analysis. A total of 163 study eyes had already undergone cataract surgery at baseline, and a total of 187 eyes (originally phakic at baseline) underwent cataract surgery any time during the follow-up period. Of these 350 eyes, 77 (22.0%) developed DR. Among the 1384 eyes that never underwent cataract surgery, 195 (14.1%) developed DR. After adjustments for age, sex, race/ethnicity, baseline hemoglobin A1c level, duration of diabetes, random blood glucose level, antidiabetic medication use, hypertension, body mass index, and smoking status, multivariable regression analysis showed that any prior cataract surgery was associated with incidence of DR (relative risk, 1.70; 95% CI, 1.26-2.30; P = .001). Subgroup analyses by race/ethnicity showed similar associations in both Malay individuals (relative risk, 1.73; 95% CI, 1.13-2.69; P = .02) and Indian individuals (relative risk, 1.93; 95% CI, 1.33-2.80; P < .001). CONCLUSIONS AND RELEVANCE The findings of this population-based cohort study suggest that prior cataract surgery was associated with a higher risk of developing DR among individuals with diabetes. Further validation is warranted to confirm this association.
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Affiliation(s)
- Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Lei Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Liang Zhang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nicholas Y. Q. Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kah-Hie Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Yong Loo Lin School of Medicine, National University Health System, Department of Ophthalmology, National University of Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Paul Mitchell
- Centre for Vision Research, The Westmead Institute for Medical Research, Westmead Hospital, Department of Ophthalmology, The University of Sydney, Westmead, New South Wales, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University Health System, Department of Ophthalmology, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University Health System, Department of Ophthalmology, National University of Singapore, Singapore
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Starr MR, Mahr MA, Iezzi R, Barkmeier AJ, Bakri SJ. Visual and Anatomic Outcomes following Cataract Surgery in Patients with Pre-operative Macular Edema Due to Retinal Vein Occlusions Managed with Intravitreal anti-VEGF. Semin Ophthalmol 2020; 35:205-209. [PMID: 32721186 DOI: 10.1080/08820538.2020.1772319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to investigate the visual and anatomic outcomes in patients with macular edema due to retinal vein occlusions (RVO) who were actively managed with intravitreal anti-vascular endothelial growth factor (VEGF) before and after cataract surgery. METHODS Retrospective, cohort study of all patients with RVO who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1st, 2012 through October 31st, 2018. There were 31 eyes that underwent cataract surgery and received at least one intravitreal anti-VEGF injection for a diagnosis of RVO within 6 months prior to surgery. Data collected included the development of subretinal or intraretinal macular fluid in the 6 months following surgery, timing of injections, number of injections, best corrected visual acuity (BCVA), and central subfield thickness (CST). RESULTS There was a significant improvement between pre- and post-operative BCVA when comparing all eyes (p values < .0001) and no significant difference in CST before and after surgery (p > .05). Eyes without fluid pre-operatively saw an improvement in visual acuity, but with an initial significant increase in CST (p = .03) that normalized over time (p = .33) without an increase in frequency of anti-VEGF injections. CONCLUSION Patients with cataracts who are actively managed for macular edema due to RVO with anti-VEGF agents may undergo cataract surgery, knowing they will have a transient increase in macular thickness that resolves without adjusting the frequency of intravitreal injections and is not visually significant.
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Affiliation(s)
- Matthew R Starr
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
| | - Michael A Mahr
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
| | - Raymond Iezzi
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
| | | | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic , Rochester, Minnesota, USA
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Evaluating the effect of intravitreal triamcinolone-moxifloxacin during cataract surgery on central macular edema in patients with preexisting diabetic retinopathy. J Cataract Refract Surg 2020; 46:1253-1259. [PMID: 32384419 DOI: 10.1097/j.jcrs.0000000000000241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate the effect of intravitreal triamcinolone acetonide-moxifloxacin at the time of cataract surgery on central macular edema in patients with preexisting diabetic retinopathy. SETTING Loma Linda University Eye Institute, California, USA. DESIGN Retrospective observational clinical study. METHODS Retrospective chart review included 75 eyes of 64 patients who had cataract surgery between February 2015 and October 2018 performed by 2 surgeons. Intravitreal injection of triamcinolone-moxifloxacin (15 mg/1 mg/mL, 0.2 mL injection with 3.0 mg triamcinolone acetonide and 0.2 mg moxifloxacin) was given at the time of surgery. Visual acuity and central macular thickness (CMT) with optical coherence tomography were recorded at preoperative and postoperative visits. RESULTS Mean visual acuity (logarithm of the minimum angle of resolution) at 4 to 6 weeks, 6 to 12 weeks, and 12 weeks or more postoperatively was 0.32, 0.35, and 0.43, respectively. Baseline mean CMT of 75 eyes was 294 μm (SD = 72). Mean CMT 4 to 6 weeks postoperatively for 46 eyes decreased from 299 μm (78) to 297 μm (79), with a mean decrease of 2 μm (50) (P = .97). Mean CMT 6 to 12 weeks postoperatively for 34 eyes increased from 317 μm (88) to 344 μm (111), with a mean increase of 26 μm (98) (P = .021). Mean CMT 12 weeks or more for 60 eyes increased from 295 μm (72) to 328 μm (108), with a mean increase of 33 μm (85) (P = .0023). CONCLUSIONS Triamcinolone acetonide-moxifloxacin maintained stability of postoperative CMT in patients undergoing cataract surgery with preexisting diabetic retinopathy in the short term, with the greatest effect at 4 to 6 weeks postoperatively.
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Kabanarou SA, Xirou T, Boutouri E, Gkizis I, Vasilias D, Bontzos G, Chatziralli I. Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery. Sci Rep 2020; 10:5534. [PMID: 32218471 PMCID: PMC7099086 DOI: 10.1038/s41598-020-62561-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
To examine preoperative use of intravitreal dexamethasone implant in patients with refractory diabetic macular edema (DME) undergoing cataract surgery. Participants in this study were 17 patients with DME refractory to previous treatment with anti-vascular endothelial growth factor agents or dexamethasone implant, and co-existent cataract. All participants received intravitreal dexamethasone implant at baseline and underwent phacoemulsification within one month after its insertion. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) changes between baseline, time of cataract surgery and postoperative months 1, 2 and 3 were evaluated. At month 1 after surgery, BCVA improved significantly from 42.3 ± 9.6 to 58.7 ± 11.9 letters compared to baseline (p < 0.001) and the improvement was sustained at month 2 and month 3 postoperatively. One month postoperatively, CST improved significantly compared to baseline (p < 0.001) and the improvement was sustained at month 2 (p < 0.001), while at month 3 CST started to increase, but remained significantly lower than baseline (p = 0.003). At month 3 postoperatively, 35.3% of patients presented recurrence of ME. Patients with refractory DME and cataract can safely undergo phacoemulsification when dexamethasone implant is inserted one month prior to surgery to ensure adequate control of postoperative inflammation and prevent deterioration of ME.
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Affiliation(s)
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Eirini Boutouri
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Ilias Gkizis
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Dimitrios Vasilias
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Cicinelli MV, Cavalleri M, Lattanzio R, Bandello F. The current role of steroids in diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1729743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Maria Vittoria Cicinelli
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Michele Cavalleri
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Retinal Vein Occlusions Preferred Practice Pattern®. Ophthalmology 2020; 127:P288-P320. [DOI: 10.1016/j.ophtha.2019.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
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Bhandari S, Biechl AC, Nguyen V, Squirrell D, Mehta H, Barthelmes D, Gillies MC. Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry. Clin Exp Ophthalmol 2020; 48:462-469. [PMID: 31885185 DOI: 10.1111/ceo.13707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
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 oedema in some eyes with DMO resulting in inferior outcomes. DESIGN Matched, case-controlled retrospective study of observational data in 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 surgery. The mean VA 6 months after surgery improved by 10.6 letters and was similar to their matched phakic controls (68.8 vs 69.2 letters; P = 0.8). Mean CST both 6 months before (341 μm) and after (360 μm) 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.
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Affiliation(s)
- Sanjeeb Bhandari
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
| | - Anne C Biechl
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vuong Nguyen
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
| | | | - Hemal Mehta
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia.,Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Daniel Barthelmes
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia.,Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
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Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology 2019; 127:P66-P145. [PMID: 31757498 DOI: 10.1016/j.ophtha.2019.09.025] [Citation(s) in RCA: 382] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Danni R, Viljanen A, Aaronson A, Tuuminen R. Preoperative anti-inflammatory treatment of diabetic patients does not improve recovery from cataract surgery when postoperatively treated with a combination of prednisolone acetate and nepafenac. Acta Ophthalmol 2019; 97:589-595. [PMID: 30620140 DOI: 10.1111/aos.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine preoperative anti-inflammatory treatment on recovery from cataract surgery in eyes of diabetic patients. METHODS A Prospective randomized clinical trial. One hundred and three eyes of 103 patients with diabetes undergoing routine cataract surgery were randomized (1:1) not to receive any preoperative anti-inflammatory medication or to receive preoperative topical anti-inflammatory medication with a combination of prednisolone acetate (10 mg/ml) and nepafenac (1 mg/ml). All eyes received postoperative anti-inflammatory combination therapy for 3 weeks. Recovery from surgery was recorded by a structured home questionnaire. Clinical outcome parameters were recorded at 28 days and 3 months. RESULTS Patient age and gender distribution, and all baseline ophthalmic and systemic parameters were comparable between the study groups. After surgery, conjunctival injection lasted 2.4 ± 1.7 days (mean ± SD) and irritation of the eye 3.3 ± 3.9 days in eyes without preoperative treatment, when compared to 1.6 ± 1.6 days (p = 0.067) and 2.4 ± 4.0 days (p = 0.431), respectively, in eyes with preoperative treatment. At 28 days, central subfield macular thickness (CSMT) increased 2.2 ± 20.2 μm in eyes without preoperative treatment, when compared 0.1 ± 25.2 μm (p = 0.670) in eyes with preoperative treatment. At 3 months, the respective CSMT change from baseline was -1.5 ± 26.9 μm and -3.4 ± 26.2 μm (p = 0.762). None of the eyes were reported with pseudophakic cystoid macular oedema (PCME) in either group. CONCLUSION Lack of preoperative anti-inflammatory treatment does not impair recovery from surgery or predispose diabetic patients to increased risk of PCME in eyes postoperatively treated with combination therapy of prednisolone acetate and nepafenac.
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Affiliation(s)
- Reeta Danni
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Antti Viljanen
- Medical Faculty University of Turku Turku Finland
- Medilaser and Coronaria Cor Group Oulu Finland
| | - Alexander Aaronson
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Unit of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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CAPTCHA as a Visual Performance Metric in Active Macular Disease. J Ophthalmol 2019; 2019:6710754. [PMID: 31281669 PMCID: PMC6590550 DOI: 10.1155/2019/6710754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose CAPTCHA (completely automated public turing test to tell computers and humans apart) was designed as a spam prevention test. In patients with visual impairment, completion of this task has been assumed to be difficult; but to date, no study has proven this to be true. As visual function is not well measured by Snellen visual acuity (VA) alone, we theorized that CAPTCHA performance may provide additional information on macular disease-related visual dysfunction. Methods This was designed as a pilot study. Active disease was defined as the presence of either intraretinal fluid (IRF) or subretinal fluid (SRF) on spectral-domain optical coherence tomography. CAPTCHA performance was tested using 10 prompts. In addition, near and distance VA, contrast sensitivity, and reading speed were measured. Visual acuity matched pseudophakic patients were used as controls. Primary outcome measures were average edit distance and percent of correct responses. Results 70 patients were recruited: 33 with active macular disease and 37 control subjects. Contrast sensitivity was found to be significantly different in both the IRF (p < 0.01) and SRF groups (p < 0.01). No significant difference was found comparing the odds ratio of average edit distance of active disease (IRF, SRF) vs. control (OR 1.09 (0.62, 1.90), 1.10 (0.58, 2.05), p=0.77, 0.77) or percent correct responses of active disease vs. control (OR 0.98 (0.96, 1.01), 1.09 (0.58, 2.05), p=0.22, 0.51) in CAPTCHA testing. The goodness of fit using logistic regression analysis for the dependent variables of either IRF or SRF did not improve accounting for average edit distance (p=0.49, p=0.27) or percent correct (p=0.89, p=0.61). Conclusions Distance VA and contrast sensitivity are positively correlated with the presence of IRF and SRF in active macular disease. CAPTCHA performance did not appear to be a significant predictor of either IRF or SRF in our pilot study.
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Prevention of macular edema in patients with diabetes after cataract surgery. J Cataract Refract Surg 2019; 45:854-869. [DOI: 10.1016/j.jcrs.2019.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023]
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Ansari WH, Han MM, Haq S, Conti FF, Silva FQ, Singh RP. Baseline Ocular Characteristics of Patients Undergoing Initiation of Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2019; 50:69-75. [PMID: 30768213 DOI: 10.3928/23258160-20190129-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/02/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with diabetic macular edema (DME) have variable anatomic and visual responses to anti-vascular endothelial growth (VEGF) treatments based on their presenting visual acuity (VA). The aim of study is to report the baseline ocular and imaging characteristics of patients presenting with DME who were treatment-naïve and who initiated anti-VEGF in routine clinical practice. PATIENTS AND METHODS Single-center, cross-sectional study of 638 patients. Subjects were divided into two VA groups: Early Treatment Diabetic Retinopathy Study (ETDRS) less than 70 and ETDRS greater than 70 and ocular variables were compared between groups. RESULTS Average central subfield thickness (CST) was 363.5 μm, cube volume was 11.7 mm3, and cube average thickness (CAT) was 326.1 μm. Additionally, 21.5% had subretinal fluid (SRF), and 50.5% had hard exudates on presentation. Eyes with ETDRS less than 70 had greater CAT (338.5 μm3 vs. 313.2 μm3; P < .001), greater cube volume (12.2 mm3 vs. 11.3 mm3; P < .001), greater CST (383.5 μm vs. 350.0 μm; P < .001), and SRF (25.5% vs. 17.3%; P = .012). Furthermore, 7.64% had glaucoma, 1.3% had dry age-related macular degeneration, 4.5% of patients were vitrectomized, and 28.7% were pseudophakic. Regarding diabetic stage, 37% had proliferative diabetic retinopathy (PDR) and 63% presented with nonproliferative diabetic retinopathy. Patients presenting with ETDRS less than 70 were more likely to have a history of vitrectomy (7.1% vs. 1.9%, P = .002) and presence of PDR (42.3% vs. 31.4%, P = .004). CONCLUSION The results describe a population of patients from a routine clinical practice not entirely represented in clinical trials, with key differences in ocular characteristics seen between VA groups. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:69-75.].
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Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World J Diabetes 2019; 10:140-153. [PMID: 30891150 PMCID: PMC6422859 DOI: 10.4239/wjd.v10.i3.140] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.
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Affiliation(s)
- Hasan Kiziltoprak
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Yasin Sakir Goker
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
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Danni R, Taipale C, Ilveskoski L, Tuuminen R. Diabetes Alone Does Not Impair Recovery From Uneventful Cataract Surgery. Am J Ophthalmol 2019; 198:37-44. [PMID: 30308203 DOI: 10.1016/j.ajo.2018.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To study the outcomes of uneventful cataract surgery in diabetic patients without retinal complications. DESIGN A post hoc treatment analysis using data from 2 double-masked randomized clinical trials. METHODS Setting: Conducted at Kymenlaakso Central Hospital, Kotka, Finland. PROCEDURE A total of 276 eyes of 266 patients undergoing routine cataract surgery were included in the study. Patients with type I or II diabetes (n = 56 eyes) were compared to nondiabetic patients (n = 220 eyes). Clinical evaluation was conducted by the operating physician, and outcome measures taken before surgery and day 28 were recorded by a research technician. RESULTS Patient age, sex distribution, and all baseline ophthalmic and surgical parameters were comparable for the nondiabetic and diabetic patient groups. Increase in aqueous flare 6.3 ± 16.4 photon units (pu)/ms vs 3.7 ± 8.9 pu/ms (mean ± standard deviation; P = .282), central retinal thickness (CRT) 12.0 ± 38.2 μm vs 5.9 ± 15.8 μm (P = .256), corrected distance visual acuity 0.57 ± 0.31 decimals vs 0.53 ± 0.35 decimals (P = .259), and patient satisfaction 9.3 ± 0.9 vs 9.2 ± 1.1 (P = .644) were comparable for nondiabetic and diabetic patients. In eyes with steroid monotherapy (n = 64), CRT increased 38.1 ± 72.8 μm in nondiabetic patients compared to 7.8 ± 6.6 μm in diabetic ones (P = .010). In eyes with nonsteroidal anti-inflammatory drug (NSAID) monotherapy (n = 157), CRT increased 5.7 ± 18.4 μm in nondiabetic patients compared to 6.2 ± 20.5 μm in diabetic ones (P = .897). Among eyes with steroid and NSAID combination therapy (n = 55), CRT increased 3.6 ± 4.1 μm in nondiabetic patients compared to 2.9 ± 3.2 μm in diabetic ones (P = .606). At 28 days postsurgery, pseudophakic cystoid macular edema (PCME) was reported in 8 eyes, of which 7 were in nondiabetic patients (P = 1.000). CONCLUSIONS Diabetic patients showed less change in CRT when compared to controls in steroid monotherapy. Other outcome measurements shows no statistical differences.
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Central retinal thickness assessment in a real life setting after cataract surgery in diabetic patients. J Fr Ophtalmol 2018; 41:904-909. [PMID: 30470488 DOI: 10.1016/j.jfo.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess in a real life setting the progression of central retinal thickness (CRT) during the first month after surgery in diabetic patients without previous diabetic macular edema (DME) and to identify potential risk factors for DME leading to increased postoperative follow-up. METHODS We conducted a prospective study of diabetic patients without history of DME who underwent uncomplicated cataract surgery. Best-corrected visual acuity (BCVA) and SD-OCT were performed 7 days and 1 month after surgery. We assumed absence of preoperative DME when there was no edema of SD-OCT at D7. Our primary endpoint was the central retinal thickness (CRT) variation between 7 days and 1 month after cataract surgery in patients without previous history of DME. RESULTS We included 55 eyes of 42 patients. BCVA was 0.57±0.72 logMar (20/80) prior to surgery and increased significantly to 0.11±0.17 (20/25) at one month (P=0.001) post-surgery. The mean baseline CRT was 209±35μm and 229±69μm (P=0.06) one month after surgery. Four eyes (7.4%) developed macular edema at one month. We found no linear correlation between HbA1C and CRT. DISCUSSION/CONCLUSION We found no link between a high level of HbA1C and postoperative increase in CRT. We found that cataract surgery in diabetic patients without previous DME has no negative impact on CRT, and visual outcomes are good. We suggest that in diabetic patients without complete visual recovery at 1-month post-cataract surgery, OCT examination should be performed in order to detect an early stage of DME.
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Kelkar A, Kelkar J, Mehta H, Amoaku W. Cataract surgery in diabetes mellitus: A systematic review. Indian J Ophthalmol 2018; 66:1401-1410. [PMID: 30249823 PMCID: PMC6173035 DOI: 10.4103/ijo.ijo_1158_17] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Particularly, the early recognition and treatment of diabetic retinopathy or maculopathy before cataract surgery influence the final visual outcome and play a major role in perioperative decision-making. Better understanding of various factors responsible for favorable outcome of cataract surgery in diabetic patients may guide us in better overalll management of these patients and optimizing the results.
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Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal Mehta
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Winfried Amoaku
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nott Inghamshire, UK
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Sarao V, Veritti D, Maurutto E, Rassu N, Borrelli E, Loewenstein A, Sadda S, Lanzetta P. Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opin Pharmacother 2018; 19:1551-1563. [PMID: 30185069 DOI: 10.1080/14656566.2018.1516206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cataracts and diabetes are widespread pathologies that are of growing concern to the global population. In diabetic patients who have had cataract surgery, the worsening of preexisting diabetic macular edema or occurrence of pseudophakic cystoid macular edema are common causes of visual impairment even with the most advanced surgical techniques available today for phacoemulsification. AREAS COVERED In this review, the authors assess the available literature to evaluate and compare different drugs, with the aim of establishing the best pharmacological strategies for the prevention and treatment of macular edema in diabetic patients undergoing cataract surgery. EXPERT OPINION Guidelines for the optimal management of diabetic macular edema in conjunction with cataract surgery or treatment of pseudophakic cystoid macular edema in diabetic patients are still lacking. To treat these conditions, clinicians need to understand the pharmacokinetics, posology, and efficacy of available drugs: topical non-steroidal anti-inflammatory drugs (NSAIDs), intravitreal anti-vascular endothelial growth factors (VEGFs), and both topical and intravitreal steroids. Diabetic patients undergoing cataract surgery should receive topical NSAIDs to prevent pseudophakic cystoid macular edema. Intravitreal anti-VEGFs and steroids, in association with cataract surgery, are indicated for patients with preexisting diabetic macular edema or those at high risk of macular edema after surgery.
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Affiliation(s)
- Valentina Sarao
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Daniele Veritti
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Erica Maurutto
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Nicolò Rassu
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Enrico Borrelli
- c Ophthalmology Clinic, Department of Medicine and Science of Ageing , University G. D'Annunzio Chieti-Pescara , Chieti , Italy
| | | | - Srinivas Sadda
- e Doheny Eye Institute , Los Angeles , CA , USA.,f Department of Ophthalmology, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Paolo Lanzetta
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
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Khodabandeh A, Fadaifard S, Abdollahi A, Karkhaneh R, Roohipoor R, Abdi F, Ghasemi H, Habibollahi S, Mazloumi M. Role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative macular edema in non-proliferative diabetic retinopathy. J Curr Ophthalmol 2018; 30:245-249. [PMID: 30197955 PMCID: PMC6127363 DOI: 10.1016/j.joco.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/10/2018] [Accepted: 04/25/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative diabetic macular edema (DME) in patients with no diabetic retinopathy or non-proliferative diabetic retinopathy (NPDR) and without macular edema. Methods In a prospective randomized clinical trial, 71 eyes from 71 diabetic patients with no diabetic retinopathy or mild NPDR and with central macular thickness (CMT) of less than 300 μm were enrolled and were randomized into two groups: combined phacoemulsification and intravitreal bevacizumab injection group and only phacoemulsification group. Our primary outcome measures included best corrected visual acuity (BCVA), CMT, and total macular volume (TMV) before and after (1 month and 3 months) the cataract surgery. Results The two groups did not show any significant difference in terms of baseline BCVA, age, CMT, stage of diabetic retinopathy. While the bevacizumab group showed lower CMT one month after the surgery compared to control group (267.3 ± 31.8 and 293.6 ± 53.7, respectively, P = 0.019), this difference did not remain significant 3 months after surgery (264.5 ± 21.9 and 291.4 ± 79.8, P = 0.089). The TMV and BCVA in the two groups showed no significant difference one month or 3 months after surgery. Considering our definition of post-cataract surgery diabetic macular edema (PME) in this study [CMT >300 μm using spectral domain optical coherence tomography (SD-OCT)], there was no significant difference between the incidence of PME at 1 month and at 3 months after surgery. Conclusions Although the intravitreal injection of bevacizumab during phacoemulsification would result in decreased macular thickness in patients with no diabetic retinopathy or NPDR and without macular edema in the early postoperative period, this effect would no longer persistent at 3 months. In addition, the BCVA and TMV showed no significant difference between the two groups at any time during follow-up period.
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Calvo P, Ferreras A, Al Adel F, Dangboon W, Brent MH. EFFECT OF AN INTRAVITREAL DEXAMETHASONE IMPLANT ON DIABETIC MACULAR EDEMA AFTER CATARACT SURGERY. Retina 2018; 38:490-496. [PMID: 28196056 PMCID: PMC5841849 DOI: 10.1097/iae.0000000000001552] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze the effects of a dexamethasone intravitreal implant (DEX; Ozurdex 700 μg; Allergan) administered immediately after cataract surgery in diabetic patients. METHODS This prospective, single-arm, open label study (NCT01748487 at ClinicalTrials.gov) involved Type 2 diabetic patients with at least mild diabetic retinopathy (DR) who underwent cataract surgery and DEX insertion after phacoemulsification, and intraocular lens implantation were enrolled. Best-corrected visual acuity and central retinal thickness (CRT) measured by spectral-domain optical coherence tomography were recorded at 1 week preoperatively, and 1 week, 1 month, and 3 months after surgery. Adverse events were also recorded. RESULTS Twenty-four eyes of 24 patients (17 [70.8%] men; mean age 63.7 ± 8.7 years) with mild nonproliferative DR (41.7%), moderate nonproliferative DR (33.3%), severe nonproliferative DR (16.7%), or treated proliferative DR (8.3%) were selected. After DEX treatment, mean CRT changed from 241.1 μm (95% confidence interval, 227.5-254.6 μm) at baseline to 236.9 μm (95% confidence interval, 223.9-249.9 μm) at 1 week (P = 0.09), 238.9 μm (95% confidence interval, 225.5-252.3 μm) at 1 month (P = 0.44), and 248 μm (95% confidence interval, 232.4-260.8 μm) at 3 months (P = 0.15). No eyes showed a postoperative increase >50 μm in the CRT at any visit. A 10% increase in CRT was found in 8.3% of eyes. Mean best-corrected visual acuity significantly improved from 0.37 (20/50) at baseline to 0.19 (20/30) at 1 week, 0.12 (20/25) at 1 month, and 0.12 (20/25) at 3 months (P < 0.001 for each comparison). Mean intraocular pressure before surgery was 13.8 mmHg, and none of the patients developed an intraocular pressure ≥22 mmHg at any visit. None of the patients developed any serious adverse events during the follow-up. CONCLUSION These short-term results suggest that a single DEX injection intraoperatively after phacoemulsification could avoid an increase in CRT after cataract surgery in diabetic patients.
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Affiliation(s)
- Pilar Calvo
- IIS-Aragon, Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Antonio Ferreras
- IIS-Aragon, Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Fadwa Al Adel
- Department of Ophthalmology, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wantanee Dangboon
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; and
| | - Michael H. Brent
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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