Posters

Cataract surgery in diabetic patients with associated diabetic retinopathy: evaluation and management

Poster Details

First Author: L.Perez MACEDONIA

Co Author(s):                        

Abstract Details

Purpose:

Evaluation in visual outcome of cataract operation in diabetic patient in correlation to their coexisting diabetic retinophaty in examination before and after the cataract surgery and their follow up. There have been tremendous advances in diabetic cataract surgery. Better technology and greater proficiency allow safer and faster surgery with better visual outcomes and shorter recovery times. In evaluation was used standard ophthalmological examination which includes : 1. Visual acuity( with or without correction) 2. Measurement of intraocular pressure ( IOP ) 3. Fundus examination (Direct or indirect) 4. Ophthalmologic Ultrasound ( A- scan and B-scan )

Setting:

5. Diabetic evaluation ( consultation of Diabetologist ) 6. Laboratory analysis, Glycemia level and Glycohemoglobin ( HbA1c ) 7. Optional records : Optical coherence tomography (OCT) and Flurescein angiography (FA) Eye department of Clinical Hospital Bitola

Methods:

Retrospective analysis of preoperative data, postoperative visual acuity and retinopathy status of all diabetic patients having undergone cataract surgery during a 4-year period (503 eyes of 351 patients, representing 20% of all cataract operations in this period in our eye department. Evaluation includes patients with Diabetes mellitus type1 and diabetic patients type 2 who are on diabetic diet, medication (anti- Diabetic- drug ) and Insulin therapy or combined therapy. Most patients were operated with Phaco procedure and a small percentage with conversion in to the ECCE of the diabetic cataract.

Results:

129 eyes (25,5%) underwent surgery with well-known retinopathy (80% nonproliferative, 20%proliferative), detected by fundus examination of the operated or fellow eye, B-scan ultrasonography or previous records,254 eyes (50,5%) without retinopathy and 120 eyes (23,9%) without the possibility to assess retinopathy status. After the operation, 28,3% (34 eyes) of the mentioned group proved to have retinopathy, 18,6 % of eyes with previously known retinopathy manifested further significant deterioration, while only 10,7% (3 eyes) among the 28 eyes having undergone laser photocoagulation prior to operation.In 3 patients (4 eyes) it was observed that it was significantly exacerbation with worsening in proliferative retinopathy

Conclusions:

Postoperative visual acuity of 0,5 or better was achieved in 75 % of eyes without retinopathy and in 40 % of eyes with retinopathy. Less then 0.5 visual acuity was achieved in more of 45 % of patients with proliferative retinopathy. The main goal for treatment diabetic related ophthalmic complications is the menagement of uderlying systemic risk factors,which are necessarily intensive glicemic control , blood pressure menagement and regulation of lipid levels. Laser photocoagulation has been considered a standard care for diabetic retinopathy. And lately intravitreal aplication of pharmacologic agents (anti VEGF injection). For the most serious complication surgery - vitrectomy.

Financial Disclosure:

None