Journal List > J Korean Ophthalmol Soc > v.53(10) > 1009199

TOOLS
An, Park, and Kwon: The Changes in Central Macular Thickness after Cataract Surgery in Patients with Diabetic Retinopathy
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(10): 1472-1479.

Published online: 17 October 2012

DOI: https://doi.org/10.3341/jkos.2012.53.10.1472

The Changes in Central Macular Thickness after Cataract Surgery in Patients with Diabetic Retinopathy

Tae Su An, MD, In Won Park, MD, PhD, Soon Il Kwon, MD

Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Address reprint requests to Soon Il Kwon, MD. Department of Ophthalmology, Hallym University Sacred Heart Hospital, #22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 431-070, Korea. Tel: 82-31-380-3834, Fax: 82-31-380-3837, magicham@hanmail.net

Received 16 March 2012       Accepted 10 September 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To evaluate the changes in central macular thickness (CMT) and incidence of macular edema (ME) after cataract surgery in diabetic patients compared with non-diabetic patients using optical coherence tomography (OCT).

Methods

The records of 138 diabetic patients and 34 non-diabetic patients who underwent cataract surgery were retrospectively reviewed. The diabetic group was divided into 5 groups according to severity of diabetic retinopathy. The diabetic group was also divided into 2 groups depending on prior panretinal photocoagulation history. The changes in CMT were examined using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery in diabetic and non-diabetic patients.

Results

The incidence of ME in the diabetic group and non-diabetic group was 19.6% and 2.9% respectively. The increased amount of CMT (ΔCMT) was significantly greater in the diabetic group compared with the non-diabetic group during the observation period (p < 0.05). The ΔCMT of eyes without a history of panretinal photocoagulation was statistically greater compared to the eyes with a history of panretinal photocoagulation at 1-, 2- and 6-months after cataract surgery (p = 0.005, 0.002, 0.008, respectively).

Conclusions

The ΔCMT and incidence of ME were significantly greater in the diabetic group compared with the non-diabetic group. Additionally, the incidence of ME was significantly greater depending on severity of diabetic retinopathy in the diabetic group.

Keywords: Cataract surgery, Central macular thickness, Diabetic retinopathy, Macular edema, Panretinal photocoagulation

Figures and Tables

Figure 1
The change in mean central macular thickness in diabetic patient group and non-diabetic patient group after cataract surgery. Paired t-test (p < 0.05). Wilcoxon signed rank test (p < 0.05). POD = postoperative day; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; CMT = central macular thickness.
jkos-53-1472-g001
Figure 2
The change in postoperative mean central macular thickness compared to preoperative mean central macular thickness (Post Op. CMT / Pre Op. CMT) in diabetic patient group and non-diabetic patient group after cataract surgery. Student t-test (p < 0.05). Mann-Whitney U test (p < 0.05). POD = postoperative day; NPDR = nonproliferative diabetic retinopathy; CMT = central macular thickness.
jkos-53-1472-g002
Figure 3
The change in postoperative mean central macular thickness compared to preoperative mean central macular thickness (Post Op. CMT / Pre Op. CMT) in eyes with and without prior panretinal photocoagulation after cataract surgery. Student t-test (p < 0.05). Mann-Whitney U test (p < 0.05). POD = postoperative day; PRP = panretinal photocoagulation; CMT = central macular thickness.
jkos-53-1472-g003
Table 1
Demographics
jkos-53-1472-i001

NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; CMT = central macular thickness.

*Student t-test (p < 0.05); †Chi-square test (p < 0.05).

Table 2
The change in mean central macular thickness in diabetic patient group and non-diabetic patient group after cataract surgery
jkos-53-1472-i002

POD = postoperative day; NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; CMT = central macular thickness.

*Paired t-test (p < 0.05); †Wilcoxon signed rank test (p < 0.05).

Table 3
Incidence of macular edema after cataract surgery
jkos-53-1472-i003

NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; PRP = panretinal photocoagulation.

Table 4
Time of incidence of macular edema after cataract surgery
jkos-53-1472-i004

NPDR = nonproliferative diabetic retinopathy; PDR = proliferative diabetic retinopathy; PRP = panretinal photocoagulation.

References

1. Rossetti L, Autelitano A. Cystoid macular edema following cataract surgery. Curr Opin Ophthalmol. 2000. 11:65–72.
2. Ray S, D'Amico DJ. Pseudophakic cystoid macular edema. Semin Ophthalmol. 2002. 17:167–180.
3. Ruiz RS, Saatci OA. Visual outcome in pseudophakic eyes with clinical cystoid macular edema. Ophthalmic Surg. 1991. 22:190–193.
4. Wright PL, Wilkinson CP, Balyeat HD, et al. Angiographic cystoid macular edema after posterior chamber lens implantation. Arch Ophthalmol. 1988. 106:740–744.
5. Ursell PG, Spalton DJ, Whitcup SM, Nussenblatt RB. Cystoid macular edema after phacoemulsification: relationship to blood-aqueous barrier damage and visual acuity. J Cataract Refract Surg. 1999. 25:1492–1497.
6. Mentes J, Erakgun T, Afrashi F, Kerci G. Incidence of cystoid macular edema after uncomplicated phacoemulsification. Ophthalmologica. 2003. 217:408–412.
7. Eriksson U, Alm A, Bjärnhall G, et al. Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls. Graefes Arch Clin Exp Ophthalmol. 2011. 249:349–359.
8. Pollack A, Leiba H, Bukelman A, Oliver M. Cystoid macular oedema following cataract extraction in patients with diabetes. Br J Ophthalmol. 1992. 76:221–224.
9. Dowler JG, Sehmi KS, Hykin PG, Hamilton AM. The natural history of macular edema after cataract surgery in diabetes. Ophthalmology. 1999. 106:663–668.
10. Gass JD, Norton EW. Cystoid macular edema and papilledema following cataract extraction. A fluorescein fundoscopic and angiographic study. Arch Ophthalmol. 1966. 76:646–661.
11. Benson WE. Cataract surgery and diabetic retinopathy. Curr Opin Ophthalmol. 1992. 3:396–400.
12. Krepler K, Biowski R, Schrey S, et al. Cataract surgery in patients with diabetic retinopathy: visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema. Graefes Arch Clin Exp Ophthalmol. 2002. 240:735–738.
13. Jurecka T, Bátková Z, Ventruba J, Synek S. [Macular edema after cataract surgery in diabetic patients without retinopathy]. Cesk Slov Oftalmol. 2007. 63:274–284.
14. Romero-Aroca P, Fernández-Ballart J, Almena-Garcia M, et al. Nonproliferative diabetic retinopathy and macular edema progression after phacoemulsification: prospective study. J Cataract Refract Surg. 2006. 32:1438–1444.
15. Squirrell D, Bhola R, Bush J, et al. A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes. Br J Ophthalmol. 2002. 86:565–571.
16. Kim SJ, Equi R, Bressler NM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007. 114:881–889.
17. Hayashi K, Igarashi C, Hirata A, Hayashi H. Changes in diabetic macular oedema after phacoemulsification surgery. Eye (Lond). 2009. 23:389–396.
18. Wang SJ, Choi SH. The Changes in macular thickness after phacoemulsification in patients with non-diabetes and nonproliferative diabetic retinopathy. J Korean Ophthalmol Soc. 2008. 49:57–64.
19. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985. 103:1796–1806.
20. Flesner P, Sander B, Henning V, et al. Cataract surgery on diabetic patients. A prospective evaluation of risk factors and complications. Acta Ophthalmol Scand. 2002. 80:19–24.
21. Henricsson M, Heijl A, Janzon L. Diabetic retinopathy before and after cataract surgery. Br J Ophthalmol. 1996. 80:789–793.
22. Kato S, Fukada Y, Hori S, et al. Influence of phacoemulsification and intraocular lens implantation on the course of diabetic retinopathy. J Cataract Refract Surg. 1999. 25:788–793.
23. Browning DJ, Fraser CM, Clark S. The relationship of macular thickness to clinically graded diabetic retinopathy severity in eyes without clinically detected diabetic macular edema. Ophthalmology. 2008. 115:533–539.
24. Miyake K. Indomethacin in the treatment of postoperative cystoid macular edema. Surv Ophthalmol. 1984. 28:554–568.
25. Yannuzzi LA, Landau AN, Turtz AI. Incidence of aphakic cystoid macular edema with the use of topical indomethacin. Ophthalmology. 1981. 88:947–954.
26. Kent D, Vinores SA, Campochiaro PA. Macular oedema: the role of soluble mediators. Br J Ophthalmol. 2000. 84:542–545.
27. Sander B, Larsen M, Engler C, et al. Diabetic macular oedema: a comparison of vitreous fluorometry, angiography, and retinopathy. Br J Ophthalmol. 2002. 86:316–320.
28. Sander B, Larsen M, Moldow B, Lund-Andersen H. Diabetic macular edema: passive and active transport of fluorescein through the blood-retina barrier. Invest Ophthalmol Vis Sci. 2001. 42:433–438.
29. Pollack A, Leiba H, Bukelman A, et al. The course of diabetic retinopathy following cataract surgery in eyes previously treated by laser photocoagulation. Br J Ophthalmol. 1992. 76:228–231.
30. Zaczek A, Zetterström C. Aqueous flare intensity after phacoemulsification in patients with diabetes mellitus. J Cataract Refract Surg. 1998. 24:1099–1104.
31. Oshika T, Kato S, Funatsu H. Quantitative assessment of aqueous flare intensity in diabetes. Graefes Arch Clin Exp Ophthalmol. 1989. 227:518–520.
32. Gardner TW, Eller AW, Friberg TR. Reduction of severe macular edema in eyes with poor vision after panretinal photocoagulation for proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 1991. 229:323–328.
33. Woo JH, Heo JW. The effects of Pa n retinal photocoagulation on macular microcirculation in diabetic retinopathy (short term follow up). J Korean Ophthalmol Soc. 1999. 40:1276–1280.
34. Nelson ML, Martidis A. Managing cystoid macular edema after cataract surgery. Curr Opin Ophthalmol. 2003. 14:39–43.
TOOLS
Similar articles