Effectiveness of intravitreal steroid at the conclusion of cataract surgery in reducing exacerbation of diabetic macular oedema and its additional treatment postoperatively: 24 weeks outcomes

Session Details

Session Title: Cataract
Session Date/Time: Friday 21/02/2020 | 10:30-13:00
Paper Time: 10:36
Venue: Fes 1.

First Author: E.Carroll UK
Co Author(s): F. Quhill                 

Abstract Details

Purpose:

Retrospective study that reviewed the prophylactic role of intravitreal steroid at the conclusion of cataract extraction (CE) in eyes with previously treated Diabetic Macular oedema (DMO): specifically, in reducing the need for additional intravitreal therapy (IVT) in the 24-weeks following surgery. We compared combining CE with an IVT steroid injection (Ozurdex or Triamcinolone) versus no injection at conclusion of surgery. Only patients with previous treated DMO undergoing cataract surgery were included. We assessed whether an IVT steroid at the end of surgery could reduce the need for additional IVT in the 24-weeks following surgery with similar visual and anatomical outcomes.

Setting:

Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK

Methods:

Records between 2011-2019 were reviewed for diabetic retinopathy eyes who had undergone CE. Patients with prior macular laser or IVT for DMO were included. Data was collected from 204 eyes which were stratified into those receiving recent treatment less than 6 months from CE versus those receiving previous treatment over 6 months from CE. Eyes were excluded if CE was complicated by posterior capsule rupture, or under 6 months observation postoperatively. Primary outcome was mean change in CMT in first 6 months following CE. Secondary outcomes include visual acuity (VA) and number of additional IVT’s in 24-weeks following CE

Results:

Overall, 1.6 (0-4) vs 0.6 (0-1) IVT reinjections were required following CE in no-prophylaxis group and steroid group respectively. 44% of recently treated eyes in the steroid group required no additional injections within 24-weeks of CE compared to only 21% with no-prophylaxis. Eyes recently treated for DME were five times likely to require additional IVT in 24 weeks after CE in no-prophylaxis group than eyes in steroid group. These results were statistically significant. No statistical difference in VA gain. CMT improvement was evident in steroid group (-102 um), in comparison with no-prophylaxis group which showed anatomical worsening (+30um).

Conclusions:

Patients with recent IVI treated DMO within six months of planned surgery would benefit from the prophylactic effect of an intravitreal steroid at the conclusion of CE; as it substantially reduces the risk for additional retreatment with IVT with sustained reduction in CMT at 24 weeks. Despite differences in CMT, no statistical difference in vision gain was found between groups. In our opinion, eyes with recent IVI treated DMO should not undergo cataract surgery without intravitreal steroid cover.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, ... travel has been funded, fully or partially, by a competing company, ... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented