Cystoid macular oedema after cataract surgery in diabetic patients : predictability, follow-up and treatment model
Year: 2021
Type: dissertation
Abstract: Purpose: To understand better the factors affecting the development of retinal complications after cataract surgery, namely pseudophakic cystoid macular oedema (PCME), in diabetic patients. The study was divided into three parts. The first study (I) aimed to shed light on the effect of systemic vasoactive medication on the risk of PCME. The second study (II) looked at the outcomes of uneventful cataract surgery in diabetic patients without retinal complications to assess whether diabetes itself serves as an independent risk factor for PCME. The third study (III) evaluated the preoperative medication of diabetic patients, specifically the importance of anti-inflammatory treatment in the eyes of diabetic patients. Methods: I. This study is a post hoc analysis of two consecutive prospective clinical studies (Ylinen et al., 2017, 2018b). A total of 269 eyes undergoing routine cataract surgery were studied. Spectral‐domain optical coherence tomography (OCT) imaging was performed before surgery and at 28 days. The patients were given postoperatively either dexamethasone, a nonsteroidal anti‐inflammatory drug (NSAID), or a combination of dexamethasone and NSAID. The effect of systemic vasoactive medication, namely angiotensin-converting enzyme inhibitors-/-angiotensin II receptor antagonists (ACE inhibitors/AT2 antagonists), beta-blockers (β‐blockers), calcium channel blockers (CCBs), nitrates or lipophilic HMG-CoA reductase inhibitors (statins), on the change in central retinal thickness (CRT) after cataract surgery was examined. II. This study is a post hoc treatment analysis using data from two double-masked RCTs (Ylinen et al., 2018a; Ylinen et al., 2018b). A total of 276 eyes of 266 patients undergoing routine cataract surgery were admitted to the study. Patients with type I or II diabetes were compared to nondiabetics. Clinical evaluation and outcome measures were conducted before surgery and on day 28. Patients were treated postoperatively with either steroids, NSAIDs, or their combination. The outcomes were analyzed according to the presence of diabetes. III. This study is a prospective randomized clinical trial with 103 eyes of 103 patients with diabetes undergoing routine cataract surgery. The patients were randomized into two groups: 1) no preoperative anti-inflammatory medication or 2) preoperative topical anti-inflammatory medication with a combination of prednisolone acetate and nepafenac. All eyes received postoperative anti-inflammatory combination therapy for three weeks. Recovery from surgery was recorded using a structured home questionnaire. Clinical outcome parameters were recorded at 28 days and three months. Results: I. In eyes with steroid monotherapy (N = 135), concomitant systemic medication with β‐blockers (12.9 ± 24.0 µm versus 28.6 ± 59.5 µm, P=0.045), CCBs (12.0 ± 22.1 µm versus 26.3 ± 55.6 µm, P=0.041) and statins (12.9 ± 22.8 µm versus 30.0 ± 61.9 µm, P=0.038) attenuated a change in CRT when compared to patients not receiving systemic medication. In multivariable analysis, the use of CCBs proved to be an independent protective factor against macular swelling at 28 days (-0.23; 95% CI [-0.43 to -0.04]; P=0.021). In eyes with NSAID monotherapy (N = 67) and those with steroid and NSAID combination therapy (N = 67), the CRT increase was moderate both with and without the use of systemic medication. Changes in vision remained insignificant. II. In eyes with steroid monotherapy (N = 64), CRT increased more in nondiabetic than in diabetic patients (38.1 ± 72.8 µm versus 7.8 ± 6.6 µm, P=0.010). In eyes with NSAID monotherapy (N = 157), CRT increased less in nondiabetic than in diabetic patients (5.7 ± 18.4 µm versus 6.2 ± 20.5 µm, P=0.897). In eyes with steroid and NSAID combination therapy (N = 55), CRT increased more in nondiabetic than in diabetic patients (3.6 ± 4.1 µm versus 2.9 ± 3.2 µm, P=0.606). At 28 days post-surgery PCME was reported in eight eyes, of which seven were in nondiabetic patients (P=1.000). III. At 28 days, CRT increased more in eyes without preoperative treatment than in eyes with preoperative treatment (2.2 ± 20.2 µm versus 0.1 ± 25.2 µm, P=0.670). At three months, the respective CRT change from baseline was greater with preoperative treatment (-1.5 ± 26.9 µm versus -3.4 ± 26.2 µm, P=0.762). None of the eyes in either group were reported to have PCME. The change in vision remained insignificant. Conclusions: I. Systemic vasoactive medication, CCBs in particular, may protect against CRT change induced by cataract surgery in eyes at risk of PCME, such as those receiving postoperative steroid monotherapy. II. Diabetic patients showed less change in CRT than controls on steroid monotherapy. Other outcome measurements showed no statistical differences. III. Lack of preoperative anti‐inflammatory treatment does not impair recovery from surgery or predispose diabetic patients to increased risk of PCME in eyes postoperatively treated with combination therapy of prednisolone acetate and nepafenac.
Source: Työväentutkimus Vuosikirja
Author: Reeta Danni
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3196354055