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Kim, Song, and Chung: Analysis of Postoperative Macular Edema in Cataract Patients with Diabetes using Optical Coherence Tomography
Original Article

J Korean Ophthalmol Soc 2010;51(3):340-346.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.3.340

Analysis of Postoperative Macular Edema in Cataract Patients with Diabetes using Optical Coherence Tomography

Jun Yong Kim, MD, Min Hye Song, MD, Sung Kun Chung, MD, PhD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Sung Kun Chung, MD, PhD Department of Ophthalmology, St. Mary's Hospital, The Catholic University of Korea #62 Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: 82-2-3779-1848, Fax: 82-2-761-6869, E-mail: eyedoc@catholic.ac.kr

Received 2 April 2009       Accepted 22 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence and progression of macular edema (ME) and associated risk factors in diabetic patients. Methods: In a prospective study, 66 eyes were assessed by optical coherence tomography (OCT) and best-corrected visual acuity was checked before operation at one and three months after operation. ME was defined as an increase of central macular thickness (CMT) by 30% or more after surgery than before operation, as measured by OCT.

Results

The incidence of ME in diabetic patients was 8.8%. The increment of CMT at three months after cataract surgery was statistically significant in the patients of diabetic duration≥10years (p=0.049). But insulin treatment, the severity of diabetic retinopathy, diabetic nephropathy and hemoglobin A1C were not significant risk factors for ME.

Conclusions

The OCT might be useful to assess the ME after cataract surgery in diabetic patients. In the patients who had long been suffered from diabetes, the incidence of ME could be higher, so cataract surgery should be carefully considered.

Keywords: Cataract surgery, Diabetes, Macular edema, Optical Coherence Tomography

References

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Figure 1.
Mean central macular thickness of study eyes at 1 and 3 months preoperatively after cataract surgery.
jkos-51-340f1.tif
Figure 2.
Representative range of cystoids abnormalities of study eyes with macular edema. (A) Preoperative optical coherence tomography (OCT). (B) Post-operative 1 month OCT. (C) Post-operative 3 months OCT.
jkos-51-340f2.tif
Table 1.
Characteristics of patients with diabetes received cataract operation
Variable Data
Age (years)  
   Mean± SD* 65.3±12.6
   Range 15∼83
Sex (%)  
   Male 26(39.4%)
   Female 40(60.6%)
Preoperative BCVA† (LogMAR‡, mean± SD*) 0.61±0.43
Preoperative central macular thickness (µm, mean± SD*) 206.38±48.77
Hemoglobin A1 C (%, mean± SD*) 7.3±1.3
Duration of diabetes (years, mean± SD*) 11.6±8.7
Treatment (number, %)  
   Insulin 18(27.3%)
   Oral hypoglycemic agents 48(72.7%)
Presence of nephropathy 21(31.8%)
Level of Diabetic Retinopathy (number, %)  
   No diabetic retinopathy 41(62.1%)
   Nonproliferative diabetic retinopathy 28(42.4%)
   Proliferative diabetic retinopathy 7(10.5%)

* SD=standard deviation

† BCVA=best corrected visual acuity

‡ LogMAR=logarithm of the minimum angle of resolution.

Table 2.
Clinical characteristics of patients with postoperative macular edema
Patient No. Sex/Age, (years) HbA1C level (%) DM duration, (years) Insulin treatment Severerity of diabetic retinopathy Blood creatinine evel, mg/dl BCVA* (LogMAR†) Macular thicknes, μm
Preop Postop Preop Postop
1 m 3 m 1 m 3 m
1 M/77 8.3 20 Yes Severe NPDR‡ 1.07 0.39 0.20 0.20 241 516 357
2 M/77 8.3 20 Yes Severe NPDR‡ 1.07 0.49 0.39 0.30 230 573 429
3 M/78 7.3 30 Yes PDR§ 1.38 1.69 0.39 0.30 137 237 227
4 M/75 10.2 1 No No DMR∏ 0.98 1.22 0 0 154 239 233
5 M/74 6.4 4 No No DMR∏ 0.76 0.30 0 0 198 295 282
6 F/65 6.8 5 No No DMR∏ 0.88 1.69 0.20 0 169 237 235

* BCVA=best corrected visual acuity

† LogMAR=logarithm of the minimum angle of resolution

‡ Nonproliferative diabetic retinopathy

§ Proliferative diabetic retinopathy

∏ Diabetic retinopathy.

Table 3.
Increased central macular thickness after cataract operation
  Increased thickness at postoperative
1 month (μm) 3 months (μm)
Insulin treatment    
   Non-insulin treated group 19.84±49.38 16.99±47.66
   Insulin treated group 48.94±32.24 31.61±29.34
   P-value 0.395 0.312
Duration of diabetes    
   <10yrs 16.57±14.54 9.21±21.06
   ≥10yrs 37.68±85.13 31.66±61.43
   P-value 0.179 0.048
Severity of diabetic retinopathy    
   No diabetic retinopathy change 14.24±25.58 8.85±22.58
   Non proliferative diabetic retinopathy 54.36±109.67 41.44±79.69
   Proliferative diabetic retinopathy 24.14±39.82 22.71±24.19
   P-value 0.398 0.268
Diabetic nephropathy (blood creatinine level)    
   <1.2 mg/dl 6.05±30.76 5.00±35.65
   ≥1.2 mg/dl 22.89±64.87 22.43±64.88
   P-value 0.262 0.802
Blood hemoglobin A1 C level    
   <7% 17.14±31.93 4.05±34.57
   ≥7% 31.67±74.56 28.55±53.69
   P-value 0.934 0.165
Table 4.
Changes of best corrected visual acuity
  Visual acuity change at postoperative
1 month (LogMAR) 3 months (LogMAR)
Central macular thickness changes    
   <30% increased 0.31±0.45 0.43±0.42
   ≥30% increased 0.76±0.63 0.83±0.68
   P-value 0.207 0.612
Insulin treatment    
   Non-insulin treated group 0.38±0.49 0.45±0.51
   Insulin treated group 0.34±0.42 0.46±0.44
   P-value 0.822 0.913
Duration of diabetes    
   <10yrs 0.30±0.46 0.55±0.48
   ≥10yrs 0.26±0.39 0.36±0.46
   P-value 0.062 0.070
Severity of diabetic retinopathy    
   No diabetic retinopathy change 0.40±0.47 0.50±0.49
   Non proliferative diabetic retinopathy 0.34±0.39 0.38±0.44
   Proliferative diabetic retinopathy 0.07±0.73 0.36±0.19
   P-value 0.433 0.537
Diabetic nephropathy (blood creatinine level)    
   <1.2 mg/dl 0.29±0.50 0.41±0.39
   ≥1.2 mg/dl 0.29±0.51 0.36±0.45
   P-value 0.777 0.434
Blood hemoglobin A1 C level    
   <7 % 0.44±0.50 0.56±0.52
   ≥7 % 0.34±0.49 0.41±0.46
   P-value 0.247 0.083
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