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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Intraocular lens selection in diabetic patients: How to increase the odds for success
Arvind Kumar Morya, Prateek Nishant, Prasanna Venkatesh Ramesh, Sony Sinha, Aarti Heda, Sarika Salodia, Ripunjay Prasad
Arvind Kumar Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
Prateek Nishant, Department of Ophthalmology, ESIC Medical College, Patna 801113, Bihar, India
Prasanna Venkatesh Ramesh, Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
Sony Sinha, Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
Aarti Heda, Department of Ophthalmology, National Institute of Ophthalmology, Pune 411000, Maharashtra, India
Sarika Salodia, Department of Safety, Global Medical Safety, Lundbeck, Singapore 307591, Singapore
Ripunjay Prasad, Department of Ophthalmology, RP Eye Institute, Delhi 110001, India
Author contributions: Morya AK and Sinha S designed and formulated the research; Nishant P, Sinha S, Ramesh PV, Salodia S, and Prasad R performed the research; Sinha S, Heda A, and Ramesh PV analyzed data and wrote the manuscript; Nishant P and Salodia S revised it; Morya AK, Nishant P, Ramesh PV, Sinha S, Heda A, Salodia S, and Prasad R read and approved the final manuscript; and all authors have made crucial and indispensable contributions towards the completion of the paper as well as agree to be held accountable for all aspects of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Arvind Kumar Morya, Doctor, MBBS, MNAMS, Academic Editor, Additional Professor, Instructor, Researcher, Teacher, Head of the Department, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com
Received: January 21, 2024
Revised: March 23, 2024
Accepted: April 23, 2024
Published online: June 15, 2024
The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.
Core Tip: The incidence of cataracts is higher in the diabetic population as compared to non-diabetics with an early presentation. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification, chances of progression of diabetic retinopathy, zonular weakness, vitreous prolapse, and diabetic macular edema. The choice of intraocular lenses (IOL) in diabetic cataract patients is a challenging scenario. The wish of diabetic cataract patients to get spectacle-free vision by implantation of premium IOLs needs to be discouraged in cases of pre-existing advanced retinopathy and maculopathy. Right from the beginning proper pre-operative examination, type of patient, the timing of surgery, and counselling about different IOLs are paramount to achieving the best results in diabetic patients undergoing cataract surgery.
