Cataract surgery risk
Morten la Cour MD
POOR visual outcome is more closely correlated with poor metabolic control rather than the trauma of the cataract surgery, according to Morten la Cour, University of Copenhagen, Denmark.
Dr la Cour addressed delegates during the ESCRS/EURETINA Symposium: The Diabetic Eye on Saturday afternoon. His presentation concerned the timing of and preparation for cataract surgery in the diabetic eye.
But what is the risk of cataract surgery in the diabetic patient?
“Standard surgical complications, such as capsular rupture, are not encountered more frequently in diabetic eyes, despite previous literature stating the opposite,” he said.
More important are the post-operative complications such as macular oedema.
“Peri-operative topical NSAID is superior to topical steroid monotherapy in the prevention of post-operative CME in both diabetics and non-diabetics,” said Dr la Cour. “This is significant, as the risk of post-operative CME is 1.8 times higher for eyes, even with neither diabetic retinopathy (DR) and no pre-operative diabetic macular oedema.” This makes diabetes mellitus the most significant risk factor for post-operative CME, and NSAID prophylaxis should thus be used in
Further, the risk post-operative macular oedema increases with the severity of DR.
Fortunately, modern minimally invasive CE most likely does not cause worsening of DR beyond natural history. And cataract extraction results in visual improvement in the vast majority of diabetics.