Review and update of cataract surgery in the diabetic eye

Risk of Progression of Nonproliferative to Proliferative Diabetic Retinopathy after Cataract Surgery

PURPOSE

To assess the influence of modern cataract surgery on the progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes (T2D).

DESIGN

A retrospective analysis of aggregated healthcare data from June 2004 to June 2024 within the TriNetX U.S. collaborative research network.

SUBJECTS

Patients 18 years or older with T2D and NPDR who either underwent routine cataract surgery or did not receive cataract surgery.

METHODS

We used the TriNetX integrated analytics platform to analyze data from U.S. healthcare organizations and conducted propensity score matching (PSM) to balance baseline demographic and clinical characteristics. We performed analysis by eye. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) and performed a sensitivity analysis evaluating patients with at least 5 years of T2D before cataract surgery.

MAIN OUTCOME MEASURES

Risk of first-time PDR diagnosis, vitreous hemorrhage (VH), tractional retinal detachment (TRD) or combined tractional and rhegmatogenous retinal detachment (CTRD), and a composite outcome at 1 year in patients who underwent cataract surgery relative to those who did not.

RESULTS

Post-PSM, there were 7178 patients in the study (n = 3589) and control (n = 3589) cohorts for right eye analysis; increased 1-year risks of PDR without complications (HR, 1.45; 95% CI, 1.09-1.92), VH (HR, 1.92; 95% CI, 1.13-3.25), and the composite outcome (HR, 1.49; 95% CI, 1.13-1.96) were observed in operated eyes. Left eye analysis included 7232 patients in the study (n = 3616) and control (n = 3616) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.58; 95% CI, 1.17-2.13), VH (HR, 2.12; 95% CI, 1.23-3.66), and the composite outcome (HR, 1.60; 95% CI, 1.21-2.13) were observed in operated eyes. Sensitivity analysis of those with at least 5 years of T2D included 4976 patients in the study (n = 2488) and control (n = 2488) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.52; 95% CI, 1.06-2.19), VH (HR, 2.50; 95% CI, 1.20-5.20), and the composite outcome (HR, 1.75; 95% CI, 1.22-2.51) were observed in operated eyes. There was no significant difference in the risk for TRD or CTRD in all analyses (all P > 0.05).

CONCLUSIONS

Modern cataract surgery was associated with progression from T2D NPDR to PDR within 1 year postoperatively.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia

PURPOSE

To compare the short-term changes in cornea, retina, and choroid of femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract.

SETTING

Affiliated Hospital of Nantong University, Jiangsu Province, China.

DESIGN

Prospective single-center study.

METHODS

Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded.

RESULTS

97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group ( P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month ( P < .05). CDVA and IOP were similar in both groups at the final visit ( P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group.

CONCLUSIONS

FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.

Effects of Femtosecond Laser-Assisted Cataract Surgery on Macular and Choroidal Thickness in Diabetic Patients

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.

Assessment of Post-Operative Pseudophakic Glaucoma by Ultrasound Biomicroscopy

Purpose

Pseudophakic glaucoma is a secondary glaucoma in which intra-ocular pressure is elevated following cataract removal. The current study aimed to evaluate the role of ultrasound biomicroscopy (UBM) in assessing post-operative pseudophakic glaucoma.

Patients and Methods

This is a case series, prospective, observational and analytical study. It included 29 eyes of 29 patients with post-operative pseudophakic glaucoma. The patients were evaluated by medical history, detailed ophthalmologic examination and UBM.

Results

UBM examination has unmasked different causes of pseudophakic glaucoma. The detected causes were classified into 3 main groups, including intraocular lens (IOL)-related causes, lens remnants and intra-ocular inflammation. Haptic-related causes were present in 9 eyes, while 6 eyes had decentered or tilted IOLs. Soemmering's ring was the main cause in 3 eyes while in one eye the cause was lens particle in the anterior chamber (AC). Silicone oil in AC with seclusio pupillae was the main cause in one eye. Peripheral anterior synechiae were detected in 8 eyes while, posterior synechiae were evident in 7 eyes. Uveitis induced by anterior chamber IOL (ACIOL) was found in 3 eyes and one eye had peripheral anterior synechiae due to neovascular glaucoma.

Conclusion

UBM is a helpful diagnostic tool to evaluate causes of pseudophakic glaucoma through adequate visualization of different angle structures.

Are smoking intensity and cessation related to cataract surgical risk in diabetic patients? Findings from the 45 and Up Study

OBJECTIVES

To investigate if smoking was related to the risk of cataract surgery in diabetic patients.

METHODS

A total of 9578 diabetic participants aged 45-65 years were enrolled from the 45 and Up Study, the largest population-based cohort study in Australia. Baseline questionnaire data were linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) database, which were both available from 2004 to 2016. Cataract surgery was determined according to the MBS. Smoking status were assessed by questionnaire. Cox regression was used to evaluate the association between smoking and incidence of cataract surgery during the follow-up.

RESULTS

During a mean follow-up of 8.4 years, 995 participants underwent cataract surgery with a corresponding incidence of 12.4 cases per 1000 person-years. In all, 10.8% of participants were current smokers at baseline, 38.7% were former smokers, and 50.5% were never smokers. The incidence of cataract surgery was non-significantly higher in never-smoker compared to former or current smokers. Regression analysis showed no significant difference in cataract surgical risk among former, current, and never smokers. In addition, neither time since quitting of smoking nor age at quitting was associated with the risk of cataract surgery, although there was a marginally significant trend in a lower risk of cataract surgery with longer smoking cessation time for participant with normal weight (P for trend = 0.05).

CONCLUSIONS

Despite that smoking was found to be related to the cataract and cataract surgery in the general population, we did not find any association between smoking and cataract surgery in diabetic patients.

Associations between physical activity and cataract treated surgically in patients with diabetes: findings from the 45 and Up Study

AIM

To investigate the association between physical activity (PA) and incidence of cataract surgery among patients with diabetes.

METHODS

We obtained data from all diabetic subjects aged 45-65 years from the baseline of the prospective 45 and Up Study from 2006 to 2009 and linked to the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) until 2016. Diabetes was defined as self-reported on questionnaire or diabetes medication history based on PBS. Cataract surgery was determined based on the MBS, and metabolic equivalent intensity level number of PA sessions per week was used to assess PA. Cox regression was used to assess the association between baseline PA and cataract surgery during the follow-up.

RESULTS

A total of 9113 diabetic participants in the 45 and Up Study were included in the current analysis with a mean age of 57.3±5.2 years (43.6% female). During a mean follow-up of 8.8 years, 950 participants (10.4% of baseline) received cataract surgery with a corresponding incidence of 12.4/1000 person-years. Cox regression analysis showed that people with less PA (p=0.01), older age (p<0.001), female gender (p<0.001), higher educational level (p<0.001) and longer diabetic duration (p<0.001) had significantly higher cataract surgery risk. Participants with a PA level of ≥14 sessions per week had 19% decreased risk of cataract surgery compared to those with <5 sessions per week. Stratification analysis showed that participants with more obesity (p value for interaction=0.03), not taking insulin (p value for interaction=0.01) and without cardiovascular disease (p value for interaction=0.008) could benefit significantly more from PA in reducing their cataract surgery risk.

CONCLUSIONS

More vigorous PA was independently associated with a reduced risk of cataract surgery in working-aged patients with diabetes.