Main Article Content
Objective: To study central macular thickness before and after uncomplicated phacoemulsification cataract surgery in diabetic patients, comparing between those with and without diabetic retinopathy, in order to estimate the incidence of developing macular edema post procedure.
Methods: Patients who underwent uncomplicated phacoemulsification cataract surgery were enrolled from March 2017 to May 2018, excluding those with preoperative retinal diseases. Central macular thickness (CMT) and best corrected visual acuity were obtained preoperatively and at 4 weeks. Forty-two diabetic patients with no diabetic retinopathy (no DR) and 23 diabetic patients with diabetic retinopathy (DR) who underwent phacoemulsification with intraocular lens insertion were enrolled. Central macular thickness were measured with Spectral domain OCT. These parameters were recorded before phacoemulsification cataract surgery and four-week after cataract operation, and were analyzed using descriptive statistics.
Results: Of the 65 patients, there were 40 males (62%) and 25 females (38%), mean age was 67±8.12 years. Forty-two diabetic patients had no DR and 23 diabetic patients had DR. There was no difference in preoperative CMT between the two groups. All eyes in this study had no macular edema prior to surgery. Phacoemulsification with posterior chamber intraocular lens implantation were performed in all eyes. No intraoperative complications were found. Mean duration from surgery date to postoperative OCT were 33 and 36 days in the no DR and DR group, respectively. Mean postoperative CMT were 235.67 ± 27.59 and 239.04 ± 29.68 µm in the no DR and DR group, respectively (p-value = 0.68). Mean CMT increase over the preoperative study 5.57 ± 12.28 µm (2.40%) in the no DR group and 5.26 ± 7.67 µm (3.28 %) in the DR group. The incidence of ME on OCT (CRT>300 µm) was 1.54%.
Conclusion: CMT in diabetic patients measured by OCT increased after uncomplicated phacoemulsification at 4 weeks in both groups but no statistically significant difference between the no DR and DR groups.
Keywords: macular edema, after cataract surgery, OCT macula, central macular thickness, CMT, phacoemulsification, diabetic retinopathy, DM
Ethics: This study was approved for ethical research in human with the human research ethics committee of Thammasat university, Thailand (Research ID : MTU-EC-OP-6-016/60)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
1. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. British Journal of Ophthalmology. 2012;96(5):614-8.
2. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC, et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology. 2016;123(2):316-23.
3. Flach AJ. The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Transactions of the American Ophthalmological Society. 1998;96:557.
4. Krepler K, Biowski R, Schrey S, Jandrasits K, Wedrich A. Cataract surgery in patients with diabetic retinopathy: visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2002;240(9):735-8.
5. Jeng C-J, Hsieh Y-T, Yang C-M, Yang C-H, Lin C-L, Wang I-J. Development of diabetic retinopathy after cataract surgery. PloS one. 2018;13(8):e0202347.
6. Kim SJ, Equi R, Bressler NM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007;114(5):881-9.
7. Baker CW, Almukhtar T, Bressler NM, Glassman AR, Grover S, Kim SJ, et al. Macular edema after cataract surgery in eyes without preoperative central-involved diabetic macular edema. JAMA ophthalmology. 2013;131(7):870-9.
8. Wang K-Y, Cheng C-K. Central retinal thickness changes and visual outcomes following uncomplicated small-incision phacoemulsification cataract surgery in diabetic without retinopathy patients and nondiabetic patients. Taiwan Journal of Ophthalmology. 2014;4(1):33-9.
9. Hee MR, Puliafito CA, Wong C, Duker JS, Reichel E, Rutledge B, et al. Quantitative assessment of macular edema with optical coherence tomography. Archives of ophthalmology. 1995;113(8):1019-29.
10. Pollack A, Leiba H, Bukelman A, Oliver M. Cystoid macular oedema following cataract extraction in patients with diabetes. British journal of ophthalmology. 1992;76(4):221-4.
11. Chen X-Y, Song W-J, Cai H-Y, Zhao L. Macular edema after cataract surgery in diabetic eyes evaluated by optical coherence tomography. International journal of ophthalmology. 2016;9(1):81.
12. Klein RM, Yannuzzi L. Cystoid macular edema in the first week after cataract extraction. American journal of ophthalmology. 1976;81(5):614-5.
13. Flesner P, Sander B, Henning V, Parving HH, De La Cour MD, Lund‐Andersen H. Cataract surgery on diabetic patients. A prospective evaluation of risk factors and complications. Acta Ophthalmologica Scandinavica. 2002;80(1):19-24.