|
1
|
Güven YZ, Işık MU, Ilgüy S, Yozgat Z. Phacoemulsification surgery in patients with diabetic macular edema: should intravitreal anti-VEGF therapy be performed before or simultaneously with surgery? Int J Ophthalmol 2025; 18:637-641. [PMID: 40256016 PMCID: PMC11947536 DOI: 10.18240/ijo.2025.04.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 12/24/2024] [Indexed: 04/22/2025] Open
Abstract
AIM To investigate the optimal anti-vascular endothelial growth factor (VEGF) treatment time in patients with diabetic macular edema (DME) scheduled for cataract surgery. METHODS The study was designed to include 4 groups. Twenty-six eyes of 26 patients with diabetes but no retinopathy (DR; group 1), 17 eyes of 17 patients with DR but no DME (group 2), and 19 eyes of 19 patients with DME who received anti-VEGF therapy concurrently with cataract surgery (group 3), and 21 eyes of 21 patients who received anti-VEGF therapy for DME 1wk before cataract surgery (group 4). The patients' best corrected visual acuity, intraocular pressure, central and mean macular thickness (CMT and MMT) values were noted on the day of surgery, postoperative day 1, week 1, and month 1. RESULTS There was a significant increase of CMT after cataract surgery in groups 1, 2, and 3 (P<0.001, P=0.044, and P=0.034, respectively) but not in group 4 (P=0.948). The change in MMT was the same as CMT (P=0.009, P=0.006, P=0.011, and P=0.172, respectively). There was a higher increase in CMT and MMT in group 2 compared to group 1 at the 1st month after surgery (P=0.002 and P=0.001, respectively). CONCLUSION In eyes with DME undergoing cataract surgery, preoperative anti-VEGF treatment may be more effective than simultaneous intravitreal anti-VEGF with surgery.
Collapse
Affiliation(s)
- Yusuf Ziya Güven
- Department of Ophthalmology, Izmir Katip Çelebi University Atatürk Educating and Research Hospital, Izmir 35200, Türkiye
| | - Mehmed Uğur Işık
- Kastamonu University Kastamonu Training and Research Hospital, Kastamonu 37200, Türkiye
| | - Serdar Ilgüy
- Kastamonu University Kastamonu Training and Research Hospital, Kastamonu 37200, Türkiye
| | - Zübeyir Yozgat
- Kastamonu University Kastamonu Training and Research Hospital, Kastamonu 37200, Türkiye
| |
Collapse
|
|
2
|
Jiang X, Xu L, Xu B, Peng H, Yang T, Zhao Y, Wu N, Zhao YE. SH2B1 promotes apoptosis in diabetic cataract via p38 MAPK pathway. iScience 2025; 28:111735. [PMID: 39898036 PMCID: PMC11786761 DOI: 10.1016/j.isci.2024.111735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 10/14/2024] [Accepted: 12/30/2024] [Indexed: 02/04/2025] Open
Abstract
Patients with diabetes face an increased risk of developing cataracts, with unclear mechanisms. Our study illuminates these mechanisms by identifying differentially expressed proteins in the lens anterior capsule of patients with diabetic cataract (DC) and age-related cataract using quantitative proteomics. We found SH2 domain-containing adapter protein B1 (SH2B1) to be crucial in DC progression. Reduced SH2B1 expression was confirmed through PCR and western blotting in patient samples, diet-induced obese mice, and high-glucose (HG)-cultured human lens epithelial cells. Under HG conditions, cell proliferation decreased, while migration and apoptosis, alongside changes in Bcl2 and caspase-3 expression, increased. Overexpressing SH2B1 alleviated these changes and influenced the p38 mitogen-activated protein kinase (MAPK) signaling pathway. This suggests SH2B1 and the p38 MAPK pathway as significant in DC pathogenesis and potential therapeutic targets. Clinically, this could lead to therapies aimed at halting or slowing DC progression.
Collapse
Affiliation(s)
- Xiaohui Jiang
- Eye Hospital of Wenzhou Medical University at Hangzhou, 618 East Fengqi Road, Hangzhou 310000, Zhejiang, China
| | - Liming Xu
- Eye Hospital of Wenzhou Medical University at Hangzhou, 618 East Fengqi Road, Hangzhou 310000, Zhejiang, China
| | - Boyue Xu
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Haotian Peng
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Tonghe Yang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yinying Zhao
- Eye Hospital of Wenzhou Medical University at Hangzhou, 618 East Fengqi Road, Hangzhou 310000, Zhejiang, China
| | - Nanxin Wu
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Yun-e Zhao
- Eye Hospital of Wenzhou Medical University at Hangzhou, 618 East Fengqi Road, Hangzhou 310000, Zhejiang, China
| |
Collapse
|
|
3
|
Loya A, Hussain ZS, Muayad J, Chauhan MZ, Soliman MK, Sallam AB. Risk of Progression of Nonproliferative to Proliferative Diabetic Retinopathy after Cataract Surgery. Ophthalmology 2025:S0161-6420(25)00125-3. [PMID: 39956206 DOI: 10.1016/j.ophtha.2025.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 01/15/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
PURPOSE To assess the influence of modern cataract surgery on the progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in patients with type 2 diabetes (T2D). DESIGN A retrospective analysis of aggregated healthcare data from June 2004 to June 2024 within the TriNetX U.S. collaborative research network. SUBJECTS Patients 18 years or older with T2D and NPDR who either underwent routine cataract surgery or did not receive cataract surgery. METHODS We used the TriNetX integrated analytics platform to analyze data from U.S. healthcare organizations and conducted propensity score matching (PSM) to balance baseline demographic and clinical characteristics. We performed analysis by eye. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) and performed a sensitivity analysis evaluating patients with at least 5 years of T2D before cataract surgery. MAIN OUTCOME MEASURES Risk of first-time PDR diagnosis, vitreous hemorrhage (VH), tractional retinal detachment (TRD) or combined tractional and rhegmatogenous retinal detachment (CTRD), and a composite outcome at 1 year in patients who underwent cataract surgery relative to those who did not. RESULTS Post-PSM, there were 7178 patients in the study (n = 3589) and control (n = 3589) cohorts for right eye analysis; increased 1-year risks of PDR without complications (HR, 1.45; 95% CI, 1.09-1.92), VH (HR, 1.92; 95% CI, 1.13-3.25), and the composite outcome (HR, 1.49; 95% CI, 1.13-1.96) were observed in operated eyes. Left eye analysis included 7232 patients in the study (n = 3616) and control (n = 3616) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.58; 95% CI, 1.17-2.13), VH (HR, 2.12; 95% CI, 1.23-3.66), and the composite outcome (HR, 1.60; 95% CI, 1.21-2.13) were observed in operated eyes. Sensitivity analysis of those with at least 5 years of T2D included 4976 patients in the study (n = 2488) and control (n = 2488) cohorts post-PSM; increased 1-year risks of PDR without complications (HR, 1.52; 95% CI, 1.06-2.19), VH (HR, 2.50; 95% CI, 1.20-5.20), and the composite outcome (HR, 1.75; 95% CI, 1.22-2.51) were observed in operated eyes. There was no significant difference in the risk for TRD or CTRD in all analyses (all P > 0.05). CONCLUSIONS Modern cataract surgery was associated with progression from T2D NPDR to PDR within 1 year postoperatively. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Asad Loya
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Zain S Hussain
- University of Medicine and Health Sciences, New York, New York
| | - Jawad Muayad
- School of Medicine, Texas A&M University, Houston, Texas
| | - Muhammad Z Chauhan
- Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohamed K Soliman
- University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio; Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt
| | - Ahmed B Sallam
- Bernice and Harvey Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Ophthalmology Department, Ain Shams University, Cairo, Egypt.
| |
Collapse
|
|
4
|
Mason RH, Minaker SA, Lahaie Luna G, Bapat P, Farahvash A, Garg A, Bhambra N, Muni RH. Changes in aqueous and vitreous inflammatory cytokine levels in nonproliferative diabetic retinopathy: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2025; 60:e100-e116. [PMID: 39043257 DOI: 10.1016/j.jcjo.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/29/2023] [Accepted: 05/27/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Diabetic retinopathy is a complication of diabetes mellitus with the potential for significant patient morbidity. Although changes to intraocular inflammatory cytokines are integral to disease pathogenesis, studies have been inconsistent about which exact cytokines are associated with diabetic retinopathy. We aimed to quantitatively summarize proangiogenic and proinflammatory cytokines in nonproliferative diabetic retinopathy (NPDR), given its frequency among those with diabetes mellitus. METHODS A systematic literature search without year limitation to February 21, 2022, identified 59 studies assessing vitreous or aqueous cytokine levels in NPDR, encompassing 1378 eyes with NPDR and 1288 eyes from nondiabetic controls. Effect sizes were generated as standardized mean differences (SMD) of cytokine concentrations between patients with NPDR and controls. RESULTS Concentrations (SMD, 95% confidence interval, and p value) of aqueous interleukin-6 (IL-6) (2.58, 1.17-3.99; p = 0.0003), IL-8 (1.56, 0.39-2.74; p = 0.009), IL-17 (13.55, 7.50-19.59; p < 0.001), transforming growth factor beta (TGF-β) (2.44, 1.02-3.85; p = 0.0007) and vascular endothelial growth factor (VEGF) (1.35, 0.76-1.93; p < 0.00001), and vitreous VEGF (1.49, 0.60-2.37; p = 0.001) were significantly higher in patients with NPDR when compared with those of healthy controls. CONCLUSIONS These cytokines may serve as disease markers of the biochemical alterations seen in NPDR and may guide interventions, as we move into an era of more targeted therapeutics.
Collapse
Affiliation(s)
- Ryan H Mason
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Samuel A Minaker
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | | | - Priya Bapat
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Armin Farahvash
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Anubhav Garg
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Nishaant Bhambra
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Toronto, ON; University of Toronto/Kensington Health Ophthalmology Biobank and Cytokine Laboratory, Toronto, ON.
| |
Collapse
|
|
5
|
Lee SH, Tseng BY, Wu MC, Wang JH, Chiu CJ. Incidence and Progression of Diabetic Retinopathy After Cataract Surgery: A Systematic Review and Meta-Analysis. Am J Ophthalmol 2025; 269:105-115. [PMID: 39179126 DOI: 10.1016/j.ajo.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/01/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE The impact of cataract surgery on diabetic retinopathy (DR) in patients with diabetes mellitus (DM) remains uncertain. This study aimed to investigate the incidence and progression of DR in patients with DM who underwent cataract surgery. DESIGN Meta-analysis. METHODS A systematic search of PubMed, Cochrane CENTRAL, and Embase databases was conducted from inception to April 2024. Randomized controlled trials or observational cohort studies involving adult patients with DM who underwent cataract surgery were included. Studies reporting data on the incidence or progression of postoperative DR were considered. Effect sizes were determined using risk ratios (RRs) with 95% confidence intervals (CIs), and meta-analysis was performed using a random-effects model. Subgroup analysis and meta-regression were conducted on perioperative demographic factors such as types of cataract surgery, DM durations, preoperative glycated hemoglobin A1c levels, and postoperative follow-up durations. RESULTS Data from 15 studies, involving 7,287 patients were analyzed. Postoperative DR incidence was elevated compared to the control group (RR, 1.38; 95% CI: 1.16-1.63; P < .001), although not significantly different in paired studies (RR, 0.85; 95% CI: 0.39-1.83; P = .671). DR progression was significantly higher after cataract surgery (RR, 1.46; 95% CI: 1.28-1.66; P < .001), irrespective of cataract surgery type and study design. Our analysis also revealed a significant increase in DR progression to sight-threatening DR, which includes clinically significant macular edema and proliferative diabetic retinopathy, following cataract surgery (RR, 1.84; 95% CI: 1.21-2.81; P = .005). Additionally, various risk factors such as preoperative HbA1c level, duration of postoperative follow-up, duration of diabetic diagnosis, age, and use of insulin therapy were investigated, However, none of these parameters significantly influenced the incidence or progression of postoperative DR. CONCLUSIONS Further research is needed to fully understand the incidence of DR after cataract surgery. However, our study provides moderate evidence supporting the progression of DR following such surgical interventions. Therefore, it is imperative to closely monitor DR progression within one year following cataract surgery in patients with DM.
Collapse
Affiliation(s)
- Ssu-Hsien Lee
- From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan
| | - Bor-Yuan Tseng
- From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan
| | - Meng-Chien Wu
- From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital (J.-H.W.), Hualien, Taiwan
| | - Cheng-Jen Chiu
- Department of Ophthalmology and Visual Science, Tzu Chi University (C.-J.C.), Hualien, Taiwan; Department of Ophthalmology, Hualien Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation (C.-J.C.), Hualien, Taiwan.
| |
Collapse
|
|
6
|
Pastore MR, Vinciguerra AL, Mura GD, Jabali AE, Tognetto D, Panozzo G. Worsening of early DME after cataract surgery. The DICAT II Study report #2. Eur J Ophthalmol 2025; 35:269-275. [PMID: 38576315 DOI: 10.1177/11206721241245743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE To analyse the long anatomical and functional outcome of a subgroup of the DICAT II study cohort, consisting of 26 patients undergoing cataract surgery and withdrawn from the study for a clinically significant worsening of early diabetic macular edema (DME). MATERIALS Patients who underwent cataract surgery and withdrawn from the DICAT II study for a clinically significant worsening of early DME with at least 12 months follow-up after the dropout. The study population was divided into two groups according to the clinical evaluation at one-year follow-up: ongoing treatment patients for DME (Treatment group, TG) and patients no longer treated (Non Treatment group, NTG). RESULTS Central foveal thickness (CFT) at baseline and dropout time were higher in TG than in the NTG, with a statistically significant difference (p < 0.05). In addition, TG patients reported a higher levels of glycated hemoglobin at time baseline compared to NTG patients (7.81 ± 1.15 vs 7.02 ± 0.56; p = 0.048). The linear regression analysis demonstrated a statistically significant relationship between the visual acuity and the ongoing treatment group at one-year follow-up (p = 0.042). CONCLUSION The study provides parameters to be considered when assessing the risk of developing persistent DME after cataract surgery in diabetic patients. In particular, CFT at baseline and dropout time have been reported to be an effective and predictable OCT biomarkers when evaluating DME progression. During the evaluation of the systemic disease, similar results were found for the glycated hemoglobin at baseline.
Collapse
Affiliation(s)
- Marco R Pastore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Abdallah El Jabali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giacomo Panozzo
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
|
7
|
Boscia F, Veritti D, Iaculli C, Lattanzio R, Freda S, Piergentili B, Varano M. Management of treatment-naïve diabetic macular edema patients: Review of real-world clinical data. Eur J Ophthalmol 2024; 34:1675-1694. [PMID: 38462923 DOI: 10.1177/11206721241237069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The high prevalence of Diabetic macular edema (DME) is a real global health problem. Its complex pathophysiology involves different pathways. Over the last decade, the introduction of intravitreal treatments has dramatically changed the management and prognosis of DME. Among the different treatment options, inhibitors of vascular endothelial growth factor (anti-VEGF) and intravitreal steroids implants represent the first-line therapy of DME. We conducted a review of electronic databases to compile the available evidence about the clinical management of DME in a clinical setting, with a special focus on treatment-naïve patients. Anti-VEGF therapies represent a valuable option for treating DME patients. However, many patients do not respond properly to this treatment and, due to its administration regimen, many patients receive suboptimal treatment in real life. Current evidence demonstrated that in patients with DME, DEX-i improved significantly both anatomic and visual outcomes. Besides eyes with insufficient anti-VEGF respond or recalcitrant DME cases, DEX-i can be effectively and safely used in treatment-naïve DME patients as first line therapy. DEX-i may be considered first line therapy in different clinical scenarios, such as DME eyes with a greater inflammatory component, patients with cardiovascular events, vitrectomized eyes, or those requiring cataract surgery. In conclusion, there are still many points for improvement pending in the clinical management of the patient with DME. Since DME treatment must follow a patient-tailored approach, selecting the best therapeutic approach for each patient requires a good understanding of the pathophysiology of DME.
Collapse
Affiliation(s)
- Francesco Boscia
- Department of Translational Medicine and Neurosciences (DiBraiN), University of Bari, Bari, Italy
| | - Daniele Veritti
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Freda
- AbbVie S.r.l., SR 148 Pontina, 04011, Campoverde, LT
| | | | - Monica Varano
- Ophthalmology Department, IRCCS - Fondazione Bietti, Rome, Italy
| |
Collapse
|
|
8
|
Kim J, Kim S, Borrelli E, Park MS, Cho BJ, Kwon S. Alterations in optical coherence tomography angiography parameters after cataract surgery in patients with diabetes. Sci Rep 2024; 14:23814. [PMID: 39394214 PMCID: PMC11469999 DOI: 10.1038/s41598-024-73830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 09/20/2024] [Indexed: 10/13/2024] Open
Abstract
This prospective study aimed to investigate microvascular changes in diabetic patients undergoing cataract surgery. Foveal avascular zone (FAZ) area, as well as vessel density (VD) in the macula and radial peripapillary capillary plexus (RPC), were compared before and after surgery. Sixty eyes (72.3%) had no diabetic retinopathy (no DR group) and 23 eyes (27.7%) had non-proliferative diabetic retinopathy (DR group). In the no DR group, the FAZ area in the superficial capillary plexus (SCP) decreased from 0.41 ± 0.13 to 0.38 ± 0.11 mm2 (P = 0.036), while no significant change was observed in the DR group (0.33 ± 0.12 to 0.30 ± 0.12 mm2, P = 0.091) at 6 months postoperatively. VD in the RPC increased from 34.4 ± 2.3% to 35.6 ± 2.3% in the no DR group (P = 0.009), but there was no significant change in the DR group (33.0 ± 3.5% vs. 34.0 ± 2.3%, P = 0.051) after 6 months. VD in the macula did not change in either group. Phacoemulsification reduced the FAZ area in the SCP and increased the VD in the RPC in diabetic patients without diabetic retinopathy at six months postoperatively.
Collapse
Affiliation(s)
- Jinsoo Kim
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Seonggyun Kim
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Min Seon Park
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Bum-Joo Cho
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Gyeonggi-do, Korea.
| |
Collapse
|
|
9
|
Morya AK, Nishant P, Ramesh PV, Sinha S, Heda A, Salodia S, Prasad R. Intraocular lens selection in diabetic patients: How to increase the odds for success. World J Diabetes 2024; 15:1199-1211. [PMID: 38983821 PMCID: PMC11229963 DOI: 10.4239/wjd.v15.i6.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- 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
| |
Collapse
|
|
10
|
Wu J, Zhou Y, Zhen F, Wang S, Li Q, Dong S. Management after cataract surgery for patients with diabetic retinopathy: a systematic review and meta-analysis. Int Ophthalmol 2024; 44:166. [PMID: 38557801 DOI: 10.1007/s10792-024-02981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/29/2023] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate the safety and effectiveness of various treatment modalities in patients with diabetic retinopathy (DR) who underwent cataract surgery. METHODS A comprehensive search for randomized controlled trials (RCTs) was conducted using the PubMed, Embase, Cochrane Library, and CNKI databases up to December 22, 2021. The safety and efficacy of treatment modalities were assessed using the risk ratio (RR) to compare the progression of DR and the mean difference to evaluate the best corrected visual acuity (BCVA) and macular thickness (MT). RESULTS The meta-analysis of the RCTs revealed that anti-VEGF (anti-vascular endothelial growth factor) drugs significantly reduced the progression of DR [RR: 0.37 (95%CI 0.19, 0.70), P = 0.002] and improved BCVA [mean difference = - 0.06 (- 0.12, - 0.01), P = 0.03] in patients with pre-existing DR who underwent cataract surgery. Steroid drugs also showed a significant reduction in macular thickness [mean difference = - 55.63 (- 90.73, - 20.53), I2 = 56%, P = 0.002] in DR patients two weeks after cataract surgery compared to the control group. The safety profiles of different management options did not differ significantly. CONCLUSION The present meta-analysis suggests that anti-VEGF drugs can effectively slow down the progression of diabetic retinopathy, improve BCVA, and reduce MT in DR patients who underwent cataract surgery. Steroid drugs also show promise in reducing MT. However, further studies with larger sample sizes are required to compare the efficacy and safety of different management options in a multi-center clinical setting.
Collapse
Affiliation(s)
- Jiahui Wu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China
| | - Yongwei Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China
| | - Fangyuan Zhen
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China
| | - Shasha Wang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China
| | - Qiuming Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China.
| | - Shuqian Dong
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China.
| |
Collapse
|
|
11
|
Su S, Wu J, Ji M, Guan Y, Shen Y, Guan HJ. Comparison of three fundus inspection methods during phacoemulsification in diabetic white cataract. Int J Ophthalmol 2023; 16:1782-1788. [PMID: 38028526 PMCID: PMC10626363 DOI: 10.18240/ijo.2023.11.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To investigate whether Wild Field Imaging System (WFIS SW-8000), 25G endoilluminator, and intraoperative optical coherence tomography (iOCT) can perform real-time screening and diagnosing in patients with suspicious diabetic retinopathy (DR) during phacoemulsification, especially in cases of white cataract. METHODS A cross-sectional study was carried out. A total of 204 dense diabetic cataractous eyes of 204 patients with suspected DR treated from April 2020 to March 2021 were included. Phacoemulsification combined with intraocular lens implantation was performed. Following the removal of the lens opacity, the 25G endo-illuminator, fundus photography, and iOCT were performed successively. Optical coherence tomography (OCT) and/or fundus fluorescein angiography (FFA) were used to verify the fundus findings postoperatively. Intraoperative and postoperative results were compared to verify the accuracy of intraoperative diagnosis in each group. RESULTS Intraoperative and postoperative examinations revealed 58 and 62 eyes with DR, respectively (positive rate, 28.43% and 30.39%, respectively). During the phacoemulsification, WFIS SW-8000 detected 44 eyes with DR (the detection rate, 70.97%); 25G endo-illuminator found 56 eyes with DR (the detection rate, 90.32%); iOCT found 46 eyes with DR (the detection rate, 74.19%); and 58 eyes with DR were found by combining the three methods (the detection rate, 93.55%). There were statistically significant differences in the diagnostic sensitivity for DR among the methods (χ2=16.36, P=0.001). CONCLUSION WFIS SW-8000, 25G endo-illuminator, iOCT, and especially their combination can be used to inspect the fundus and detect DR intraoperatively; they are helpful for the timely diagnosis and treatment of DR in patients with dense cataract.
Collapse
Affiliation(s)
- Shu Su
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jian Wu
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yu Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yao Shen
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Huai-Jin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| |
Collapse
|
|
12
|
Khattab AM, Hagras SM, Lotfy NM. Pre-operative versus post-operative intravitreal aflibercept injection for management of DME in patients undergoing cataract surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3223-3229. [PMID: 37329361 DOI: 10.1007/s00417-023-06138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023] Open
Abstract
AIM The aim of this paper is to investigate the need of deferring cataract surgery until treating the co-existing diabetic macular edema (DME) using intravitreal (IVI) anti-vascular endothelial growth factor (anti-VEGF). METHODS A prospective randomized interventional study included diabetic patients with visually significant cataract and DME. Patients were divided into 2 groups. Group A received three preoperative intravitreal (IVI) aflibercept injections with a monthly interval; the third injection was given intra-operatively. Group B received a single intra-operative injection, and two post-operative injections with a monthly interval. The primary outcome measure was the change in central macular thickness (CMT) at 1st and 6th month post-operative. The secondary outcome measures were best corrected visual acuity (BCVA) at same points and any documented adverse effects. RESULTS Forty patients were enrolled in the study, 20 patients in each group. Means of CMT at 1 month post-operatively were significantly higher in group B than group A but no statistical difference at 6 months. There was no statistical difference between the 2 groups regarding BCVA at 1 or 6 months post-operatively. Compared with the baseline values, BCVA and CMT improved significantly after 1 and 6 months within both groups. CONCLUSION IVI of aflibercept given before cataract surgeries does not seem to have superior effect over postoperative injections in either macular thickness or visual outcomes. Hence, preoperative controlling of DME might not be mandatory in patients undergoing cataract surgery. CLINICAL TRIAL REGISTRATION The study is registered in clinical trial. Gov (NCT05731089).
Collapse
Affiliation(s)
- Abeer M Khattab
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Ophthalmology, Al-Hadi Clinic, Jabriya, Kuwait
| | - Sherein M Hagras
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Nancy M Lotfy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
|
13
|
Song P, Li P, Huang Z, Yuan Y, Wei M, Wang C, Zhang G, Ji M, Guan H. Pro-Fibrotic Role of Interleukin-4 in Influencing Idiopathic Epiretinal Membrane in Cataract Patients: Analysis From Clinical-Experimental Approaches. Transl Vis Sci Technol 2023; 12:23. [PMID: 37982769 PMCID: PMC10668627 DOI: 10.1167/tvst.12.11.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023] Open
Abstract
Purpose To evaluate the role of interleukin-4 in influencing idiopathic epiretinal membrane (iERM) formation and early progression post cataract surgery (PCS) from clinical and experimental perspectives. Methods We quantified levels of IL-4 in aqueous humor (AH) samples from 22 iERM patients and 31 control subjects collected before and 20 hours after cataract surgeries using ELISA. After a 3-month follow-up, the association between IL-4 levels and iERM progression measurements was identified. In addition, in vitro studies were conducted to investigate the effects of IL-4 on primary rat retinal Müller glia proliferation, migration, and glial-mesenchymal transition (GMT). Results Concentrations of IL-4 were significantly higher in preoperative AH samples from iERM patients versus controls (P = 0.006). Postoperatively, although IL-4 levels were elevated in both groups compared to their respective preoperative levels, they were even more obviously so in the iERM group (P < 0.001). Multivariate linear regression analyses revealed that, postoperatively, IL-4 level elevation was positively associated with macular volume and thickness increase (both P < 0.05) in iERM patients. However, no correlations were observed between IL-4 level (changes) and clinical characters in the controls. In vitro studies demonstrated that IL-4 promoted Müller glia proliferation and migration and increased the expression of GMT-related markers in a manner independent of transforming growth factor-β1 (TGF-β1). Conclusions IL-4 plays a crucial pro-fibrotic role in iERM formation and early progression 3 months PCS possibly by stimulating Müller glia proliferation, migration, and GMT in a TGF-β1-independent manner. Translational Relevance The current study suggests the potential of IL-4 as a novel therapeutic target for iERM.
Collapse
Affiliation(s)
- Pei Song
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Department of Ophthalmology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, China
| | - Pengfei Li
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Zeyu Huang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yurong Yuan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Miao Wei
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Congyu Wang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
- Medical School of Nantong University, Nantong, Jiangsu, China
| | - Guowei Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
|
14
|
Guo S, Li C, Lian L, Le Z, Ren Y, Liao YX, Shen J, Hou JT. Fluorescence Imaging of Diabetic Cataract-Associated Lipid Droplets in Living Cells and Patient-Derived Tissues. ACS Sens 2023; 8:3882-3891. [PMID: 37737091 DOI: 10.1021/acssensors.3c01439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Diabetic cataract (DC) surgery carries risks such as slow wound healing, macular edema, and progression of retinopathy and is faced with a deficiency of effective drugs. In this context, we proposed a protocol to evaluate the drug's efficacy using lipid droplets (LDs) as the marker. For this purpose, a fluorescent probe PTZ-LD for LDs detection is developed based on the phenothiazine unit. The probe displays polarity-dependent emission variations, i.e., lower polarity leading to stronger intensity. Especially, the probe exhibits photostability superior to that of Nile Red, a commercial LDs staining dye. Using the probe, the formation of LDs in DC-modeled human lens epithelial (HLE) cells is validated, and the interplay of LDs-LDs and LDs-others are investigated. Unexpectedly, lipid transfer between LDs is visualized. Moreover, the therapeutic efficacy of various drugs in DC-modeled HLE cells is assessed. Ultimately, more LDs were found in lens epithelial tissues from DC patients than in cataract tissues for the first time. We anticipate that this work can attract more attention to the important roles of LDs during DC progression.
Collapse
Affiliation(s)
- Shuai Guo
- School of Chemistry and Chemical Engineering, Guangxi Key Laboratory for Polysaccharide Materials and Modifications, Guangxi Minzu University, Nanning 530008, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Chen Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Eye Hospital of Wenzhou Medical University, Wenzhou 325003, China
| | - Lili Lian
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Eye Hospital of Wenzhou Medical University, Wenzhou 325003, China
| | - Zhenmin Le
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Eye Hospital of Wenzhou Medical University, Wenzhou 325003, China
| | - Yueping Ren
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Eye Hospital of Wenzhou Medical University, Wenzhou 325003, China
| | - Ye-Xin Liao
- School of Chemistry and Chemical Engineering, Guangxi Key Laboratory for Polysaccharide Materials and Modifications, Guangxi Minzu University, Nanning 530008, China
- Guangxi Higher Education Institutes Key Laboratory for New Chemical and Biological Transformation Process Technology, Nanning 530008, China
| | - Jianliang Shen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Zhejiang Engineering Research Center for Tissue Repair Materials, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325001, China
| | - Ji-Ting Hou
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| |
Collapse
|
|
15
|
Li H, Niu Y, Rong A, Bi Y, Xu W, Cui H. Effect of Adjunctive Intravitreal Conbercept Injection at the End of 25G Vitrectomy on Severe Proliferative Diabetic Retinopathy: 6-Month Outcomes of a Randomised Controlled Trial. Ophthalmol Ther 2023; 12:1173-1180. [PMID: 36752956 PMCID: PMC10011228 DOI: 10.1007/s40123-023-00664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the effect of pre-operative versus pre-operative plus post-operative intravitreal conbercept (IVC) injection on severe proliferative diabetic retinopathy (PDR). METHODS This was a prospective, comparative and randomised study. A total of 84 patients who underwent vitrectomy for severe PDR were included in this study. Patients were randomly divided into control (41 eyes) and experiment (43 eyes) groups. Patients in the experiment group received adjunctive pre-operative and post-operative IVC injection, whereas patients in the control group only received pre-operative IVC injection. The incidence of post-operative vitreous haemorrhage (POVH), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined. RESULTS The incidence of early POVH was significantly different between the two groups, but no significant difference was observed between groups at 3 and 6 months. In the experiment group, the BCVA was significantly improved 1 month after surgery when compared with the control group (p 0.019). There was no marked difference in the mean post-operative BCVA at 3 and 6 months between groups (p 0.063 and 0.082). CRT was significantly lower in the experiment group than in the control group at 1 and 3 months after surgery (p 0.037 and 0.041), but there was no significant difference at 6 months (p 0.894). CONCLUSION Additional IVC injected at the end of surgery improves the POVH and BCVA at the early stage after surgery in severe PDR, but this benefit is absent at 6 months. Further studies are needed to investigate the effect of IVC at the end of vitrectomy. TRIAL REGISTRATION chictr.org.cn identifier: ChiCTR2200060735. Retrospectively registered, register date: 9 June 2022.
Collapse
Affiliation(s)
- Houshuo Li
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yunli Niu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Wei Xu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, School of Medicine, Tongji University, 150 Jimo Road, Shanghai, 200120, China.
| |
Collapse
|
|
16
|
Ma J, Kao X, Sun X, Zhang M, Liu Y. Clinical observation of femtosecond laser-assisted cataract surgery for diabetic cataract. Am J Transl Res 2023; 15:249-255. [PMID: 36777870 PMCID: PMC9908458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/09/2022] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To observe the clinical efficacy of femtosecond laser-assisted cataract surgery (FLACS) for diabetic cataract (DC). METHODS One hundred and seven cases of DC admitted between August 2018 and August 2021 were enrolled, and their clinical data were retrospectively analyzed. Of them, 53 cases treated with conventional phacoemulsification (Phaco) cataract surgery (CPS) were set as the control group (the Con) and 54 cases receiving FLACS were set as the observation group (the Obs). Clinical data such as effective phaco time (EPT), color doppler energy (CDE), best corrected visual acuity (BCVA), visual quality, corneal endothelial cell (CEC) count (CECC), and complication rate were compared and analyzed. Finally, multivariate Cox regression analysis was performed to analyze the prognostic factors based on the incidence of complications in DC patients. RESULTS The Obs had significantly lower EPT and CDE compared to the Con, as well as markedly elevated BCVA and visual quality at one month after operation compared to the preoperative levels and the Con. The CECC of the Obs differed insignificantly from that before surgery and was higher versus the Con. Moreover, the incidence of postoperative complications (corneal edema, fibrin exudation, pigment dispersion, and posterior synechia of the iris) was lower in the Obs. Moreover, the treatment method was an independent prognostic factor affecting the prognosis of DC patients. CONCLUSIONS The above analysis suggests the superior efficacy of FLACS to CPS for DC, as it can more significantly reduce EPT, CDE, CEC loss, and the incidence of postoperative complications with a positive effect on improving BCVA, visual quality, and patient prognosis.
Collapse
|
|
17
|
Khalil MMAA, Mansour HO, Tawfik AMR, Elmahdy AG. Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema. BMC Ophthalmol 2022; 22:492. [PMID: 36522705 PMCID: PMC9756666 DOI: 10.1186/s12886-022-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation. METHODS Retrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 μm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months). RESULTS After 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030). CONCLUSIONS Combined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.
Collapse
Affiliation(s)
| | - Hosam Othman Mansour
- Magrabi Eye Hospital Tanta, Tanta, Egypt ,grid.411303.40000 0001 2155 6022Department of Ophthalmology, Faculty of Medicine, Al Azhar University, Damietta branch, New Damietta, Egypt
| | | | - Ahmed Gomaa Elmahdy
- grid.411303.40000 0001 2155 6022Department of Ophthalmology, Al Azhar University, Cairo, Egypt
| |
Collapse
|
|
18
|
Fallico M, Lotery A, Maugeri A, Favara G, Barchitta M, Agodi A, Russo A, Longo A, Bonfiglio V, Avitabile T, Marolo P, Borrelli E, Parisi G, Cennamo G, Furino C, Reibaldi M. Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis. Eye (Lond) 2022; 36:2239-2246. [PMID: 34795415 PMCID: PMC9674685 DOI: 10.1038/s41433-021-01847-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare outcomes of cataract surgery combined with either anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy or dexamethasone implant (DEX) in patients with diabetic macular oedema (DMO). METHODS Pubmed and Embase databases were searched for studies reporting outcomes of diabetic cataract surgery combined with either anti-VEGF or DEX, with a follow-up ≥3 months. The primary outcome was the mean change in central macular thickness (CMT). Mean change in best corrected visual acuity (BCVA) was considered as a secondary outcome. The mean difference between baseline and post-treatment values (MD) with 95%-Confidence Interval (95%CI) was calculated and meta-analyses were performed. RESULTS Nine-teen studies were included, 8 in the DEX group and 11 in the anti-VEGF group. A significant reduction of macular thickness was shown in the DEX group at 3 months (MD = -98.35 µm; 95% CI, -147.15/-49.54), while mean CMT change was non-significant in the anti-VEGF group (MD = -21.61 µm; 95% CI, -59.46/16.24; test of group differences, P < 0.001). At 3 months, no difference in visual gain was found between the two groups (P = 0.13). CONCLUSIONS In DMO patients, cataract surgery combined with DEX seems to provide better anatomical outcomes compared with cataract surgery combined with anti-VEGF therapy. However, our evidence was limited by significant heterogeneity. Randomised trials comparing these two different combined approaches are warranted.
Collapse
Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy.
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90127, Palermo, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Gilda Cennamo
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Claudio Furino
- Department of Ophthalmology, University of Bari, 70124, Bari, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| |
Collapse
|
|
19
|
Yen CY, Yen JC, Chen CC, Hu HY, Cheng FS, Tseng PC. Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study. Medicine (Baltimore) 2022; 101:e30115. [PMID: 35984152 PMCID: PMC9387960 DOI: 10.1097/md.0000000000030115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to investigate the therapeutic effect of cataract surgery along with simultaneous intravitreal injection (IVI) of aflibercept on diabetic macular edema (DME). This cohort study enrolled 106 patients aged >40 years with type 2 diabetes mellitus and DME who received cataract surgery from January 1, 2016, to October 31, 2020. The baseline and mean data of the following parameters were collected: age, sex, glycated hemoglobin level, diabetic retinopathy (DR) grading, previous DR treatments including IVI of anti-vascular endothelial growth factor and pan-retinal photocoagulation, intraocular pressure, use of intraocular pressure-lowering medication, central subfield thickness (CST), and log MAR visual acuity (VA). Patients were categorized into 2 groups based on whether they received aflibercept IVI or not during cataract surgery and were compared using the t test and Fisher exact test for continuous and discrete variables, respectively. Beta coefficient and standard error were calculated using multiple linear regression analysis to identify the explanatory variables predictive of the net change of CST and log MAR VA. There was no difference in the net change in CST (15.24 ± 45.07 μm vs 18.62 ± 33.84 μm, P = .772) and log MAR VA (-0.27 ± 0.29 vs -0.37 ± 0.31, P = .215). Gender, glycated hemoglobin level, aflibercept IVI during cataract surgery, and baseline CST did not interfere with the morphological and functional outcomes of DME in cataract surgery. Older age was significantly and independently associated with a greater net change in log MAR VA. Proliferative DR was significantly and independently associated with a greater net change in CST and log MAR VA. A greater baseline log MAR VA was significantly and independently associated with lower net change in log MAR VA. Simultaneous aflibercept IVI for treating DME may not interfere with the functional and tomographic parameters of cataract surgery relative to cataract surgery alone. Factors influencing the outcomes of patients with DME undergoing cataract surgery are as follows: age, baseline DR staging, and baseline VA. Identifying these factors of DME preoperatively may be an important consideration in preventing it from progressing and for improving the overall visual prognosis.
Collapse
Affiliation(s)
- Chu-Yu Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Ju-Chuan Yen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Feng-Shiang Cheng
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Po-Chen Tseng
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Special Education, University of Taipei, Taipei, Taiwan
- *Correspondence: Po-Chen Tseng, No. 10, Sec. 4, Renai Rd., Daan Dist., Taipei City 10629, Taiwan (e-mail: )
| |
Collapse
|
|
20
|
Mason RH, Minaker SA, Lahaie Luna G, Bapat P, Farahvash A, Garg A, Bhambra N, Muni RH. Changes in aqueous and vitreous inflammatory cytokine levels in proliferative diabetic retinopathy: a systematic review and meta-analysis. Eye (Lond) 2022:10.1038/s41433-022-02127-x. [PMID: 35672457 DOI: 10.1038/s41433-022-02127-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/05/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is a major complication of diabetes mellitus, where in its most advanced form ischemic changes lead to the development of retinal neovascularization, termed proliferative diabetic retinopathy (PDR). While the development of PDR is often associated with angiogenic and inflammatory cytokines, studies differ on which cytokines are implicated in disease pathogenesis and on the strength of these associations. We therefore conducted a systematic review and meta-analysis to quantitatively assess the existing body of data on intraocular cytokines as biomarkers in PDR. METHODS A comprehensive search of the literature without year limitation was conducted to January 18, 2021, which identified 341 studies assessing vitreous or aqueous cytokine levels in PDR, accounting for 10379 eyes with PDR and 6269 eyes from healthy controls. Effect sizes were calculated as standardized mean differences (SMD) of cytokine concentrations between PDR and control patients. RESULTS Concentrations (SMD, 95% confidence interval, and p-value) of aqueous IL-1β, IL-6, IL-8, MCP-1, TNF-α, and VEGF, and vitreous IL-2, IL-4, IL-6, IL-8, angiopoietin-2, eotaxin, erythropoietin, GM-CSF, GRO, HMGB-1, IFN-γ, IGF, IP-10, MCP-1, MIP-1, MMP-9, PDGF-AA, PlGF, sCD40L, SDF-1, sICAM-1, sVEGFR, TIMP, TNF-α, and VEGF were significantly higher in patients with PDR when compared to healthy nondiabetic controls. For all other cytokines no differences, failed sensitivity analyses or insufficient data were found. CONCLUSIONS This extensive list of cytokines speaks to the complexity of PDR pathogenesis, and informs future investigations into disease pathogenesis, prognosis, and management.
Collapse
Affiliation(s)
- Ryan H Mason
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Samuel A Minaker
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | | | - Priya Bapat
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Armin Farahvash
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Anubhav Garg
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Nishaant Bhambra
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Vision and Research Centre, Toronto, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada.
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Kensington Vision and Research Centre, Toronto, ON, Canada.
- University of Toronto/Kensington Health Ophthalmology Biobank and Cytokine Laboratory, Toronto, ON, Canada.
| |
Collapse
|
|
21
|
Song P, Li P, Geng W, Qin M, Su S, Zhou T, Yuan Y, Zhang G, Wu J, Ji M, Guan H. Cytokines possibly involved in idiopathic epiretinal membrane progression after uncomplicated cataract surgery. Exp Eye Res 2022; 217:108957. [PMID: 35077755 DOI: 10.1016/j.exer.2022.108957] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 12/29/2022]
Abstract
Epiretinal membrane (ERM) is a common retinal fibrotic disorder disease causing visual impairment and metamorphopsia. Recently, increasing attention has been devoted to ERM progression after uncomplicated cataract surgery. Cytokines, which play a role in diverse physiological and pathological activities in eyes, are suggested to be involved in these postoperative changes. However, few studies have investigated the post-cataract surgery cytokine expression changes in ERM eyes and their roles in the postoperative changes. The purpose of this study was to evaluate the aqueous levels of cytokines in eyes with idiopathic epiretinal membrane (iERM) both pre- and post-cataract surgery, and their correlations with postoperative iERM progression. In this study, aqueous humor (AH) samples were collected from iERM eyes (n = 25) and non-iERM eyes (n = 23) from 48 patients (48 eyes) undergoing uncomplicated cataract surgery preoperatively and 20 h postoperatively. Samples were analyzed for 48 cytokines with multiplex bead-based immunoassay. Correlations between cytokine level changes (postoperation vs. preoperation) and three-month postoperative best-corrected visual acuity (BCVA) and optical coherence tomography measure changes were evaluated in iERM eyes. We found that in iERM eyes, the levels of 4 cytokines exhibited significant elevations when compared with those in the controls (all p ≤ 0.0015) preoperatively. Postoperatively, the concentrations of 21 cytokines were higher than the preoperative levels in iERM eyes (all p ≤ 0.0015), among which GRO-α, IL-8, and MCP-3 levels showed more pronounced changes than the controls. Additionally, in iERM eyes, IL-4 level changes showed moderate positive correlations with MV (r = 0.492, p = 0.028) and MT (r = 0.481, p = 0.032) changes. LogMAR changes were positively correlated with IL-1α (r = 0.553, p = 0.011), IL-12(P40) (r = 0.544, p = 0.013), and MCP-3 (r = 0.588, p = 0.006) level changes. No significant cytokine-level-change differences were found between eyes with and without postoperative cystoid macular edema development. In conclusion, cataract surgery will bring great alterations to the specific intraocular cytokine microenvironment inherently in eyes with iERM. Many fibrotic and inflammatory cytokines showing elevated levels or relationships with clinical characteristics are suggested to be involved in the pathogenesis and post-cataract surgery progression of iERM; however, further investigations are needed to discern their real roles.
Collapse
Affiliation(s)
- Pei Song
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Pengfei Li
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Wenjing Geng
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Miaomiao Qin
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Shu Su
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Tianqiu Zhou
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yurong Yuan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Guowei Zhang
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jian Wu
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Min Ji
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Huaijin Guan
- Eye Institute, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| |
Collapse
|
|
22
|
Comparison of VEGF level in tears post phacoemulsification between non-proliferative diabetic retinopathy and non-diabetic patients. J Diabetes Metab Disord 2021; 20:2073-2079. [PMID: 34900842 DOI: 10.1007/s40200-021-00875-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/08/2021] [Indexed: 12/14/2022]
Abstract
Background Progression of diabetic retinopathy post cataract surgery is related to the increased level of vascular endothelial growth factor (VEGF) in ocular fluid post operatively. The aim of this study was to compare the VEGF level in tears post phacoemulsification between non-proliferative diabetic retinopathy (NPDR) and non-diabetic patients. Methods This was a prospective cohort study and was conducted from June 2017 to May 2019. Patients with underlying NPDR who were planned for phacoemulsification were recruited in this study. Non-diabetic patients who were planned for phacoemulsification were included as control group. Tears samples were collected using Schirmer strip two weeks prior to operation, at day (D) 7 and D30 post phacoemulsification. Tears samples were analyzed for VEGF level. Results A total of 65 patients were recruited in this study (NPDR: 32 and control: 33). There was significant increase of VEGF levels in tears from pre operation to D7 post phacoemulsification in NPDR (p < 0.001) and control (p < 0.001). There was also significant reduction of tear VEGF level from D7 to D30 post phacoemulsification in both groups (p < 0.001 in NPDR and p = 0.027 in control). The tear VEGF level was significantly higher in NPDR group compared to control at D7 post phacoemulsification (149.4 SD 55.2 pg/mL vs 109.7 SD 48.7 pg/mL, p = 0.003). Conclusion VEGF level in tears showed significant elevation post early cataract surgery in NPDR compared to non-diabetic patient. Therefore, tears VEGF level may provide as a non-invasive method to predict progression of diabetic retinopathy post operation among diabetic patients.
Collapse
|
|
23
|
Vadalà M, Trapani VS, Amato M, Bongiovanni G, Alaimo F, Cillino S, Bonfiglio VME. Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study. Eur J Ophthalmol 2021; 32:2760-2770. [PMID: 34878320 DOI: 10.1177/11206721211062037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of preoperative intravitreal dexamethasone implant (DexI) on functional and anatomic outcomes in patients with diabetic macular edema (DME) who underwent phacoemulsification cataract surgery. METHODS Prospective and non-comparative study conducted on consecutive DME patients undergoing cataract surgery. DexI was administered 15 days before surgery and in a pro re nata regime after surgery. Main outcome measures were mean change in central retinal thickness (CRT), central subfield thickness (CST), total macular volume (TMV), and central subfield volume (CSV) from baseline to month-12. Secondary outcome was mean change in best corrected visual acuity (BCVA). RESULTS Forty eyes were included in the study. CRT significantly decreased from 410.4 ± 64.8 µm at baseline to 303.2 ± 24.3 µm at month-12, p < 0.0001. Similarly, CST was significantly reduced from 436.4 ± 120.4 µm at baseline to 322.9 ± 54.2 µm at month-12, p < 0.0001. Total macular volume and CSV were significantly reduced from 9.95 ± 1.68 mm3 and 0.38 ± 0.11 mm3 at baseline to 8.49 ± 0.83 mm3 and 0.31 ± 0.05 mm3 at month-12, respectively (p < 0.0001 each, respectively). BCVA significantly improved from 0.26 ± 0.17 Snellen equivalent at baseline to 0.65 ± 0.19 at month-12, p < 0.0001. Mean DexI administered during the study were 2.0 ± 0.3. Neither DME subtype nor previous treatment status had any effect on functional or anatomic outcomes. Regarding safety, one (2.5%) eye developed ocular hypertension, which was successfully controlled with topical hypotensive treatment. CONCLUSIONS DexI was and effective and safe strategy for managing DME in diabetic patients undergoing uneventful cataract surgery.
Collapse
Affiliation(s)
- Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy.,IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | | | - Mario Amato
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Giuseppe Bongiovanni
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Francesco Alaimo
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Salvatore Cillino
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | | |
Collapse
|
|
24
|
Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
Collapse
|
|
25
|
Song W, Conti TF, Gans R, Conti FF, Silva FQ, Saroj N, Singh RP. Prevention of Macular Edema in Patients With Diabetic Retinopathy Undergoing Cataract Surgery: The PROMISE Trial. Ophthalmic Surg Lasers Imaging Retina 2021; 51:170-178. [PMID: 32211907 DOI: 10.3928/23258160-20200228-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the safety and efficacy of intravitreal aflibercept injection (IAI) in patients with diabetic retinopathy (DR) in the prevention of macular edema (ME) following cataract surgery. PATIENTS AND METHODS This phase 2, prospective, interventional, single-masked, randomized trial at a single academic center included 30 patients who were 18 years of age or older with nonproliferative DR and undergoing cataract surgery with phacoemulsification. Patients received 2 mg intravitreal aflibercept (0.05 mL) or sham injection during cataract surgery. Main outcome measures included treatment adverse events (AEs), best-corrected visual acuity (BCVA), and incidence of ME (defined as presence of cystoid abnormalities as detected by optical coherence tomography at any follow-up visit), a 30% or greater increase from preoperative baseline in central subfield macular thickness, or a BCVA decrease of more than 5 ETDRS letters from Day 7 due to retinal thickening. RESULTS There were similar incidences of AEs between the two groups and no clinically serious ocular AEs in either group. The IAI group had fewer ME events at Day 14 (13% vs. 53%; P = .022), but there was no significant difference in ME events at Day 30 (27% vs. 60%; P = .057), Day 60 (27% vs. 60%; P = .057), or Day 90 (40% vs. 67%; P = .161). Compared to the study group, the control group had a significantly greater increase in central subfield thickness (CST) at Day 30 (50.05 μm vs. 7.95 μm; P = .040) and Day 60 (56.45 μm vs. 3.02 μm; P = .010). However, the difference in CST between groups was no longer significant at Day 90 (50.31 μm vs. 18.48 μm; P = .12). There were no significant differences in BCVA gains between the IAI and sham group at the end of the follow-up period (Day 90, ETDRS letters: 9.88 vs. 8.52; P = .66). CONCLUSIONS Use of IAI in patients with DR for prevention of ME following cataract surgery showed no significant AEs. Although there were significant differences in ME incidence and retinal thickness at periods of time, there was no clinically meaningful benefit in terms of VA. Further larger trials are needed to validate these findings. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:170-178.].
Collapse
|
|
26
|
Howaidy A, Eldaly ZH, Anis M, Othman TM. Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab. Eur J Ophthalmol 2021; 32:205-212. [PMID: 33726537 DOI: 10.1177/11206721211001275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. PATIENTS AND METHODS A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. RESULTS The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. CONCLUSION Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.
Collapse
Affiliation(s)
- Ahmed Howaidy
- Department of Ophthalmology, Aswan University, Sahary City, Egypt
| | - Zeiad H Eldaly
- Department of Ophthalmology, Assiut University Hospital, Assiut, Egypt
| | - Mohamed Anis
- Department of Ophthalmology, Cairo University, Giza, Egypt
| | | |
Collapse
|
|
27
|
PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY: A Meta-Analysis. Retina 2020; 39:1720-1731. [PMID: 29975344 DOI: 10.1097/iae.0000000000002221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the clinical effectiveness of intravitreal bevacizumab (IVB) injection combined with cataract surgery in the treatment of patients with cataract and coexisting diabetic retinopathy (DR). METHODS Pertinent comparative studies were identified through systemic searches of PubMed, EMBASE, and the Cochrane Controlled Trials Register up to March 1, 2016. Outcome measures included corrected distance vision acuity, central macular thickness, and progression of DR and maculopathy. A meta-analysis was performed using RevMan (Cochrane Collaboration, Oxford, United Kingdom). RESULTS Six studies describing a total of 283 eyes were identified. The meta-analysis results showed that corrected distance vision acuity measured at 1 month and 3 months after cataract surgery was significantly better in the IVB groups than in the control groups (P < 0.00001 and P = 0.01), whereas the corrected distance vision acuity at 6 months did not vary significantly between the 2 groups (P = 0.24). Similarly, the central macular thickness at 1, 3, and 6 months after surgery was significantly thinner in the IVB groups than in the control groups (P = 0.01, P = 0.0004, and P = 0.01, respectively). At 6 months, the progression of postoperative DR and maculopathy occurred more frequently in the control group than in the IVB group (P = 0.0001 and P < 0.0001, respectively). CONCLUSION Our meta-analysis indicates that cataract surgery combined with IVB seems to be an effective treatment in patients with coexisting DR in the short term (up to 6 months). More randomized, prospective, and large-sample-sized trials are needed to evaluate the long-term effects of IVB at the time of cataract surgery in patients with DR.
Collapse
|
|
28
|
Goh JKS, Lim LL. Dealing with co-existent cataract and diabetic macular oedema: An increasingly common conundrum now solved? Clin Exp Ophthalmol 2020; 48:424-426. [PMID: 32367639 DOI: 10.1111/ceo.13764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jonathan K S Goh
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
| | - Lyndell L Lim
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
| |
Collapse
|
|
29
|
Hu X, Ding Y, Wang Z, Hu J, Liu X, Tang Y, Zhong M, Luan J. Expression of Neovascular Associated Factors PEDF and αB-crystallin in Human Lens Epithelial Cells. Curr Eye Res 2020; 45:1385-1389. [PMID: 32208037 DOI: 10.1080/02713683.2020.1746813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To investigate the expression of pigment epithelium-derived factor (PEDF) and αB-crystallin in human lens epithelial cells (LEC) and explore their relationships with diabetes. Methods: Lens anterior capsules attached with LEC were collected from cataract surgeries in patients with or without diabetes, and grouped as following: non-diabetes mellitus (NDM) group, no diabetic retinopathy (NDR) group, non-proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. The expression of PEDF and αB-crystallin in all groups was determined by Western blot and immunofluorescence assay. Results: PEDF and αB-crystallin protein were both detected in LEC. PEDF was mainly distributed in the cytoplasm, whereas αB-crystallin was present in both cytoplasm and nucleus. The levels of PEDF protein and αB-crystallin protein in LEC were significantly increased with the appearance and aggravation of diabetic retinopathy (DR) (p < .01). Conclusion: The expression of PEDF and αB-crystallin protein is both positively correlated with the progression of DR, which may contribute to the regulation of iris neovascularization.
Collapse
Affiliation(s)
- Xinying Hu
- Department of Ophthalmology, Southeast University Zhongda Hospital , Nanjing, China.,School of Medicine, Southeast University , Nanjing, China
| | - Yuzhi Ding
- Department of Ophthalmology, Southeast University Zhongda Hospital , Nanjing, China
| | - Zhirong Wang
- School of Medicine, Southeast University , Nanjing, China
| | - Juan Hu
- School of Medicine, Southeast University , Nanjing, China
| | - Xuelian Liu
- Institute of Life Sciences, Southeast University , Nanjing, China
| | - Yuyan Tang
- Institute of Life Sciences, Southeast University , Nanjing, China
| | - Ming Zhong
- School of Medicine, Southeast University , Nanjing, China
| | - Jie Luan
- Department of Ophthalmology, Southeast University Zhongda Hospital , Nanjing, China
| |
Collapse
|
|
30
|
Ikegami Y, Takahashi M, Amino K. Evaluation of choroidal thickness, macular thickness, and aqueous flare after cataract surgery in patients with and without diabetes: a prospective randomized study. BMC Ophthalmol 2020; 20:102. [PMID: 32169068 PMCID: PMC7071624 DOI: 10.1186/s12886-020-01371-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In diabetic eyes, various choroidal abnormalities are noted in addition to changes in the retinal circulation, and the risk of increased aqueous flare and retinal thickening after cataract surgery is higher in diabetic eyes. Inflammation caused by surgery induces breakdown of the blood-retinal barrier and affects the retina, although the influence on the choroid is unknown. Several researchers have evaluated the choroidal thickness (CT) after cataract surgery in patients with diabetes; however, the results are inconsistent. The purpose of this study was to evaluate the influence of uneventful small-incision phacoemulsification cataract surgery on the subfoveal choroidal thickness (SCT), the central macular thickness (CMT), and aqueous flare in patients with diabetes. METHODS This study included 59 randomly selected eyes (33 eyes of patients with diabetes and 26 eyes of control patients without diabetes) undergoing small-incision cataract surgery. Among the diabetic eyes, 26 were without diabetic retinopathy, and the remaining eyes had non-proliferative diabetic retinopathy. Aqueous flare, CMT, and SCT measurements were performed before and at 1 week, 1 month, and 3 months after surgery. RESULTS The postoperative CMT continued to increase significantly until 3 months in both groups. Although the CMT was more in patients with diabetes than in patients without diabetes during the follow-up period, there was no significant difference between the two groups. The aqueous flare value increased until 3 months after surgery in both groups. Although the increase was significant at 3 months after surgery in patients with diabetes, the increase in controls was not significant. The aqueous flare values differed significantly between the two groups before and at 3 months after surgery. There was no significant within-group or between-group difference in pre- and postoperative SCT values. CONCLUSION In diabetic eyes with early stage of retinopathy, even small-incision cataract surgery can induce increased aqueous flare and macular thickening until 3 months, although there is no significant change in the choroidal thickness. Further studies are essential to evaluate choroidal changes after the cataract surgery in diabetic eyes.
Collapse
Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Miyuki Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kana Amino
- Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan
| |
Collapse
|
|
31
|
Lu AQ, Prensky JG, Baker PS, Scott IU, Mahmoud TH, Todorich B. Update on medical and surgical management of submacular hemorrhage. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1725474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Amy Q. Lu
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Ingrid U. Scott
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Tamer H. Mahmoud
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, and Associated Retinal Consultants, PC, Royal Oak, MI, USA
| | | |
Collapse
|
|
32
|
Jiang T, Gu J, Zhang P, Chen W, Chang Q. The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study. BMC Ophthalmol 2020; 20:43. [PMID: 32013913 PMCID: PMC6998156 DOI: 10.1186/s12886-020-1321-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effect of intravitreal conbercept (IVC) injections on the incidence of postoperative vitreous hemorrhage (VH) in eyes undergoing surgery for severe proliferative diabetic retinopathy. METHODS This was a pilot prospective, comparative, and randomized study. Thirty patients, who underwent vitrectomy for severe proliferative diabetic retinopathy, were assigned randomly to either group 1 (intravitreal conbercept [IVC] injection at the end of pars plana vitrectomy) or group 2 (no IVC injection). Postoperative follow-up was performed on the first day, first week, first month, third month, sixth month and first year after surgery. The primary outcome was the incidence of postoperative VH. Secondary outcomes were the initial time of vitreous clearing (ITVC), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after surgery. RESULTS A total of 30 eyes, from 30 patients, were included. Fifteen eyes were enrolled in the IVC group and fifteen in the control group. The incidence of early and late postoperative VH was not significantly different between the control and IVC groups. ITVC was shorter in the IVC group than that in the control group, but this was not significant (7.38 ± 10.66 vs 13.23 ± 17.35, P = 0.31). Final BCVA, 1 year after surgery, showed significant improvement compared to baseline in both groups. However, analysis of the BCVA at any postoperative visit after surgery showed no significant differences between the two groups. There were two cases of recurrent VH identified at 3 and 6 months after surgery in each group, requiring a second round of surgery. Foveal thickness was significantly different between the two groups at the 3-month, 6-month and 1-year follow-up visits. CONCLUSIONS In this pilot study, the effect of IVC injection in reducing the incidence of postoperative VH after diabetic vitrectomy at the end of vitrectomy was not shown. TRIAL REGISTRATION The study was registered with the Chinese Clinical Trial Registry. (Reference Number: ChiCTR1800015751).
Collapse
Affiliation(s)
- Tingting Jiang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.,Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Junxiang Gu
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.,Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Peijun Zhang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.,Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wenwen Chen
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.,Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China. .,Key Laboratory of Myopia of National Health Commission, Fudan University, Shanghai, China. .,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| |
Collapse
|
|
33
|
Moshfeghi AA, Thompson D, Berliner AJ, Saroj N. Outcomes in Patients with Diabetic Macular Edema Requiring Cataract Surgery in VISTA and VIVID Studies. Ophthalmol Retina 2019; 4:481-485. [PMID: 31924543 DOI: 10.1016/j.oret.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the impact of cataract surgery on visual and anatomic outcomes in patients with diabetic macular edema treated with intravitreal aflibercept injection (IAI) or laser control and who did not require rescue therapy. DESIGN Post hoc analysis of 2 phase 3 trials, Study of Intravitreal Aflibercept Injection in Patients with Diabetic Macular Edema (VISTA) and Intravitreal Aflibercept Injection in Vision Impairment Due to DME (VIVID). PARTICIPANTS Fifty-four patients (laser treatment, n = 11; IAI, n = 43) who underwent cataract surgery during the study period. METHODS In VISTA and VIVID, patients received IAI 2 mg every 4 weeks, IAI 2 mg every 8 weeks after 5 monthly doses, or laser control through week 100. Starting at week 24, if rescue treatment criteria were met, IAI patients received laser therapy, and laser therapy patients received IAI 2 mg every 8 weeks (after 5 monthly doses). Patients who received rescue treatment before cataract surgery were excluded. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in the laser control and pooled IAI groups before and after cataract surgery. RESULTS The cumulative incidence of cataract surgery did not depend on treatment group assignment (rate ratio, = 1.517; 95% confidence interval, 0.782-2.944; P = 0.2174). At the last study visit before surgery, BCVA was 62.2 and 56.9 letters and CRT was 342 μm and 301 μm in the laser control and IAI groups, respectively. At the first study visit after cataract surgery, BCVA was improved significantly in both the laser control and IAI groups to 73.5 letters (P = 0.010 compared with last visit before surgery) and 67.2 letters (P < 0.001 compared with last visit before surgery), respectively. Corresponding change in CRT was a modest increase to 364 μm (P > 0.05 compared with last visit before surgery) and 359 μm (P = 0.013 compared with last visit before surgery), respectively. CONCLUSIONS Incidence of cataract surgery was similar in both treatment groups. Despite a modest worsening in CRT after cataract surgery, BCVA was improved in both treatment groups.
Collapse
Affiliation(s)
- Andrew A Moshfeghi
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | | | | | | |
Collapse
|
|
34
|
Yip VCH, Laude A, Tan KA, Ding J, Wong E, Agrawal R. A longitudinal study of choroidal changes following cataract surgery in patients with diabetes. Diab Vasc Dis Res 2019; 16:369-377. [PMID: 31007056 DOI: 10.1177/1479164119841536] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the structural changes in the choroid of diabetic patients following cataract surgery, using choroidal vascularity index and choroidal thickness. METHODS A prospective case-control study was conducted in 18 diabetic and 18 non-diabetic patients undergoing cataract surgery (phacoemulsification) in one eye. Enhanced depth imaging optical coherence tomography images were obtained before and after surgery. Niblack's image binarization of images was performed to derive the choroidal vascularity index. Independent sample T-test compared the differences of choroidal vascularity index and choroidal thickness between diabetic and non-diabetic patients. RESULTS The baseline choroidal vascularity index was significantly lower in diabetic patients for both operated (mean difference vs non-diabetic: 0.0184, 95% CI: 0.004-0.0324, p = 0.012) and non-operated (mean difference vs non-diabetic: 0.0145, 95% CI: 0.003-0.0256, p = 0.012) eyes. Choroidal thickness increased following cataract surgery (diabetes: mean difference = 12.4, 95% CI: 0.70-24.0, adjusted p = 0.036; non-diabetic: mean difference = 21.0, 95% CI: 4.39-37.6, adjusted p = 0.011). CONCLUSION Diabetic patients have reduced choroidal vascularity index than non-diabetic patients, suggestive of possible reduction in choroidal vascularity in diabetes. Choroidal thickness increased following cataract surgery in both diabetic and non-diabetic patients.
Collapse
Affiliation(s)
| | - Augustinus Laude
- 1 National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Kara Anne Tan
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jianbin Ding
- 3 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Elizabeth Wong
- 1 National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Rupesh Agrawal
- 1 National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 3 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
|
35
|
Prevention of macular edema in patients with diabetes after cataract surgery. J Cataract Refract Surg 2019; 45:854-869. [DOI: 10.1016/j.jcrs.2019.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023]
|
|
36
|
A Systematic Review and Meta-Analysis of Clinical Outcomes of Intravitreal Anti-VEGF Agent Treatment Immediately after Cataract Surgery for Patients with Diabetic Retinopathy. J Ophthalmol 2019; 2019:2648267. [PMID: 31143469 PMCID: PMC6501156 DOI: 10.1155/2019/2648267] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/25/2019] [Accepted: 03/31/2019] [Indexed: 02/08/2023] Open
Abstract
Aims To examine possible benefits of intravitreal anti-vascular endothelial growth factor (VEGF) agent treatment immediately after cataract surgery for patients with diabetic retinopathy (DR). Methods A comprehensive literature search was performed using the Cochrane collaboration methodology to identify randomized controlled trials (RCTs) and comparative studies of cataract surgery with or without anti-VEGF agent treatment for any diabetic retinopathy. Meta-analyses were performed for clinical outcome parameters including changes in macular thickness (MT), best-corrected visual acuity (BCVA), incidence of diabetic retinopathy and maculopathy progression, laser treatment rate, and other complications. Results Nine RCTs and 3 nonrandomized comparative studies were identified and used for comparing cataract surgery with intravitreal bevacizumab (IVB) or intravitreal ranibizumab (IVR) treatment (338 eyes, intervention group) to cataract surgery alone (329 eyes, control group). Analysis of all data showed that the mean BCVA at 1 week postoperatively had no statistically significant difference in the two groups, but at 1, 3, and 6 months postoperatively, the mean BCVA was statistically significantly better in the anti-VEGF treatment group than that in cataract surgery alone group. Analysis of all data showed that the mean MT was statistically significantly less in the anti-VEGF treatment group at 1 week and 1, 3, and 6 months postoperatively (P=0.05, P=0.006, P=0.0001, and P=0.0001, respectively); but postoperative clinical outcomes were differentiated from the type of anti-VEGF agents, IVB or IVR, and the existing macular edema preoperatively. Intravitreal anti-VEGF agent treatment statistically significantly reduced the incidence of diabetic retinopathy progression and maculopathy progression compared to the control group (P=0.0003, P < 0.00001, respectively). Conclusion IVB or IVR treatment immediately after cataract surgery may represent a safe and effective strategy to prevent postoperative macular thickening or reduce macular edema and result in greater mean improvements in visual acuity for diabetic patients.
Collapse
|
|
37
|
Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World J Diabetes 2019; 10:140-153. [PMID: 30891150 PMCID: PMC6422859 DOI: 10.4239/wjd.v10.i3.140] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.
Collapse
Affiliation(s)
- Hasan Kiziltoprak
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Yasin Sakir Goker
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
| |
Collapse
|
|
38
|
Browning DJ, Stewart MW, Lee C. Diabetic macular edema: Evidence-based management. Indian J Ophthalmol 2018; 66:1736-1750. [PMID: 30451174 PMCID: PMC6256891 DOI: 10.4103/ijo.ijo_1240_18] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 12/15/2022] Open
Abstract
Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetic retinopathy with an increasing prevalence tied to the global epidemic in type 2 diabetes mellitus. Its pathophysiology starts with decreased retinal oxygen tension that manifests as retinal capillary hyperpermeability and increased intravascular pressure mediated by vascular endothelial growth factor (VEGF) upregulation and retinal vascular autoregulation, respectively. Spectral domain optical coherence tomography (SD-OCT) is the cornerstone of clinical assessment of DME. The foundation of treatment is metabolic control of hyperglycemia and blood pressure. Specific ophthalmic treatments include intravitreal anti-VEGF drug injections, intravitreal corticosteroid injections, focal laser photocoagulation, and vitrectomy, but a substantial fraction of eyes respond incompletely to all of these modalities resulting in visual loss and disordered retinal structure and vasculature visible on SD-OCT and OCT angiography. Efforts to close the gap between the results of interventions within randomized clinical trials and in real-world contexts, and to reduce the cost of care increasingly occupy innovation in the social organization of ophthalmic care of DME. Pharmacologic research is exploring other biochemical pathways involved in retinal vascular homeostasis that may provide new points of intervention effective in those cases unresponsive to current treatments.
Collapse
Affiliation(s)
- David J Browning
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Chong Lee
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina, USA
| |
Collapse
|
|
39
|
Kelkar A, Kelkar J, Mehta H, Amoaku W. Cataract surgery in diabetes mellitus: A systematic review. Indian J Ophthalmol 2018; 66:1401-1410. [PMID: 30249823 PMCID: PMC6173035 DOI: 10.4103/ijo.ijo_1158_17] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Particularly, the early recognition and treatment of diabetic retinopathy or maculopathy before cataract surgery influence the final visual outcome and play a major role in perioperative decision-making. Better understanding of various factors responsible for favorable outcome of cataract surgery in diabetic patients may guide us in better overalll management of these patients and optimizing the results.
Collapse
Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal Mehta
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Winfried Amoaku
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nott Inghamshire, UK
| |
Collapse
|
|
40
|
Torabi H, Sadraei M, Jadidi K, Alishiri AA. Choroidal thickness changes following cataract surgery in patients with type 2 diabetes mellitus. J Curr Ophthalmol 2018; 31:49-54. [PMID: 30899846 PMCID: PMC6407067 DOI: 10.1016/j.joco.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/15/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the choroidal thickness changes after cataract surgery in type 2 diabetic patients. Methods Three groups of patients were enrolled into this prospective study. Group A included diabetic patients without diabetic retinopathy (DR) or with mild non-proliferative diabetic retinopathy (NPDR) who underwent phacoemulsification, Group B included non-diabetic patients with significant cataract who underwent phacoemulsification, and Group C included diabetic patients without DR or with mild NPDR who followed up without surgical procedure. Choroidal thickness in 5 points (subfoveal and 500 μ temporal, nasal, superior and inferior to the fovea) and central macular thickness were measured before surgery using enhanced depth spectral domain optical coherence tomography. Patients were re-evaluated 1 week, 1 month, and 3 months after operation and compared with the baseline values. Results In total, 63 eyes from 63 patients were enrolled to this study, including 21 eyes in Group A, 22 eyes in Group B, and 20 eyes in Group C. After three months of follow-up of the patients, choroidal thickness in all measured points was decreased significantly, and central macular thickness was increased significantly following cataract surgery in diabetic eyes (Ggroup A); meanwhile, both choroidal thickness and central macular thickness were increased significantly in non-diabetic eyes (Group B). In Group C, choroidal thickness and central macular thickness had no significant changes, after three months. Conclusion Unlike in non-diabetic eyes, choroidal thickness in diabetic patients decreased following cataract surgery.
Collapse
Affiliation(s)
- Hamidreza Torabi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadraei
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali-Agha Alishiri
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
41
|
Khodabandeh A, Fadaifard S, Abdollahi A, Karkhaneh R, Roohipoor R, Abdi F, Ghasemi H, Habibollahi S, Mazloumi M. Role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative macular edema in non-proliferative diabetic retinopathy. J Curr Ophthalmol 2018; 30:245-249. [PMID: 30197955 PMCID: PMC6127363 DOI: 10.1016/j.joco.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/10/2018] [Accepted: 04/25/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative diabetic macular edema (DME) in patients with no diabetic retinopathy or non-proliferative diabetic retinopathy (NPDR) and without macular edema. Methods In a prospective randomized clinical trial, 71 eyes from 71 diabetic patients with no diabetic retinopathy or mild NPDR and with central macular thickness (CMT) of less than 300 μm were enrolled and were randomized into two groups: combined phacoemulsification and intravitreal bevacizumab injection group and only phacoemulsification group. Our primary outcome measures included best corrected visual acuity (BCVA), CMT, and total macular volume (TMV) before and after (1 month and 3 months) the cataract surgery. Results The two groups did not show any significant difference in terms of baseline BCVA, age, CMT, stage of diabetic retinopathy. While the bevacizumab group showed lower CMT one month after the surgery compared to control group (267.3 ± 31.8 and 293.6 ± 53.7, respectively, P = 0.019), this difference did not remain significant 3 months after surgery (264.5 ± 21.9 and 291.4 ± 79.8, P = 0.089). The TMV and BCVA in the two groups showed no significant difference one month or 3 months after surgery. Considering our definition of post-cataract surgery diabetic macular edema (PME) in this study [CMT >300 μm using spectral domain optical coherence tomography (SD-OCT)], there was no significant difference between the incidence of PME at 1 month and at 3 months after surgery. Conclusions Although the intravitreal injection of bevacizumab during phacoemulsification would result in decreased macular thickness in patients with no diabetic retinopathy or NPDR and without macular edema in the early postoperative period, this effect would no longer persistent at 3 months. In addition, the BCVA and TMV showed no significant difference between the two groups at any time during follow-up period.
Collapse
|
|
42
|
Acan D, Calan M, Er D, Arkan T, Kocak N, Bayraktar F, Kaynak S. The prevalence and systemic risk factors of diabetic macular edema: a cross-sectional study from Turkey. BMC Ophthalmol 2018; 18:91. [PMID: 29649995 PMCID: PMC5897948 DOI: 10.1186/s12886-018-0753-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 03/29/2018] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to evaluate the prevalence of diabetic macular edema (DME) utilizing optical coherence tomography (OCT), and to clarify the effects of the systemic findings and risk factors on the development of DME. Methods This cross-sectional study was conducted in the departments of ophthalmology and endocrinology at the Dokuz Eylul University School of Medicine in Izmir, Turkey. The demographics, type and duration of diabetes mellitus, treatment modality, smoking and alcohol consumption habits, as well as the systemic blood pressure, renal functional tests, hemoglobulin A1c level, serum lipid profile, and 24-h urine albumin level were noted and statistically analyzed. The relationships between the systemic findings and DME were studied. Results Four-hundred and thirteen eyes of 413 diabetic patients who were examined between January 2011 and July 2012 were enrolled in this study. The prevalence of DME was 15.3% among the patients. The males exhibited DME significantly more frequently than the females (p = 0.031), and the duration of diabetes was significantly longer in those patients with DME (p < 0.001). Those patients without DME frequently used antihyperlipidemic drugs and had a higher level of high density lipoprotein cholesterol (p = 0.040 and p = 0.046, respectively). The patient’s alcohol consumption, nephropathy, neuropathy, previous cataract surgery, severity of diabetic retinopathy, and insulin usage were statistically significant factors with regard to the DME prevalence. Conclusions This study demonstrated the prevalence of DME in Turkey by utilizing OCT. The development of DME can be avoided or limited and the response to treatment may be improved by the regulation of the DME risk factors.
Collapse
Affiliation(s)
- Durgul Acan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
| | - Mehmet Calan
- Department of Endocrinology and Metabolism, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Duygu Er
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tugba Arkan
- Department of Endocrinology and Metabolism, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nilufer Kocak
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Firat Bayraktar
- Department of Endocrinology and Metabolism, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Suleyman Kaynak
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
|
43
|
Moshfeghi AA, Shapiro H, Lemmon LA, Gune S. Impact of Cataract Surgery during Treatment with Ranibizumab in Patients with Diabetic Macular Edema. ACTA ACUST UNITED AC 2018; 2:86-90. [DOI: 10.1016/j.oret.2017.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
|
|
44
|
Oyewole K, Tsogkas F, Westcott M, Patra S. Benchmarking cataract surgery outcomes in an ethnically diverse and diabetic population: final post-operative visual acuity and rates of post-operative cystoid macular oedema. Eye (Lond) 2017. [PMID: 28643796 DOI: 10.1038/eye.2017.96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PurposeTo determine visual acuity and rates of post-operative cystoid macular oedema (CMO) in an ethnically diverse and predominantly diabetic population.MethodsThe study was undertaken over a one year period. Snellen visual acuity (VA) was measured pre and 4-8 weeks post-operatively and optical coherence topography (OCT) was performed at baseline and post-operatively. No eyes received prophylactic non-steroidal anti-inflammatory drugs (NSAIDs) prior to or after surgery.ResultsOut of 262 eyes, 59% were in the Black, Asian and minority ethnic group (BAME), 57% had a history of diabetes mellitus and 34% had pre-existing diabetic retinopathy. 76% of all eyes achieved 6/12 post-operative VA at the first postoperative review and the incidence of post-operative CMO within the study population was 7.6%. In patients with a history of diabetes mellitus the incidence of post-operative CMO was 10.7% compared to 3.5% in those without diabetes. This was found to be clinically significant (P=0.0297).ConclusionWe believe this is the first study to benchmark standards for care in this demographic of patients. A history of diabetes mellitus, irrespective of whether there is diabetic retinopathy or not, is an independent risk factor for the development of post-operative CMO in patients undergoing cataract surgery (P=0.0297). Ethnicity is not an independent risk factor for the development of post-operative CMO.
Collapse
Affiliation(s)
- K Oyewole
- Ophthalmology Department, Whipps Cross University hospital, Leytonstone, London, UK
| | - F Tsogkas
- Ophthalmology Department, Whipps Cross University Hospital, London, UK
| | - M Westcott
- Medical Retina Department, Moorfields Eye Hospital, London, UK
| | - S Patra
- Ophthalmology Department, Whipps Cross University Hospital, London, UK
| |
Collapse
|
|
45
|
Denniston AK, Chakravarthy U, Zhu H, Lee AY, Crabb DP, Tufail A, Bailey C, Akerele T, Al-Husainy S, Brand C, Downey L, Fitt A, Khan R, Kumar V, Lobo A, Mahmood S, Mandal K, Mckibbin M, Menon G, Natha S, Ong JM, Tsaloumas MD, Varma A, Wilkinson E, Johnston RL, Egan CA. The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema. Br J Ophthalmol 2017; 101:1673-1678. [PMID: 28487377 DOI: 10.1136/bjophthalmol-2016-309838] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/14/2017] [Accepted: 03/19/2017] [Indexed: 12/11/2022]
Abstract
AIM To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery. METHODS Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. INCLUSION CRITERIA eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. MAIN OUTCOME MEASURE rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye. RESULTS 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01). CONCLUSIONS This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
Collapse
Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | | | | | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, USA
| | | | - Adnan Tufail
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | - Clare Bailey
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Toks Akerele
- Department of Ophthalmology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
| | - Sahar Al-Husainy
- Department of Ophthalmology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Christopher Brand
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Louise Downey
- Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
| | - Alan Fitt
- Department of Ophthalmology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - Rehna Khan
- Department of Ophthalmology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Vineeth Kumar
- Department of Ophthalmology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Unit, Bedford Hospitals NHS Trust, Bedford, UK
| | | | - Kaveri Mandal
- Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
| | - Martin Mckibbin
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Geeta Menon
- Department of Ophthalmology, Frimley Park Hospital, Frimley, UK
| | - Salim Natha
- Department of Ophthalmology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jong Min Ong
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marie D Tsaloumas
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Atul Varma
- Department of Ophthalmology, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Elizabeth Wilkinson
- Department of Ophthalmology, Northern Devon Healthcare NHS Trust, Barnstaple, UK
| | | | - Catherine A Egan
- The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
| | | |
Collapse
|
|
46
|
Boscia F, Giancipoli E, D'Amico Ricci G, Pinna A. Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol 2017; 28:23-28. [PMID: 27661663 DOI: 10.1097/icu.0000000000000328] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to describe all the treatment modalities used to prevent and manage macular oedema in diabetic patients undergoing cataract surgery. RECENT FINDINGS Topical NSAIDs have been proposed to be an effective strategy to prevent postsurgical macular oedema (PME) in diabetic patients. The prophylactic use of intravitreal antivascular endothelial growth factors (anti-VEGF) drugs and steroids in these patients, even if effective, brings some concerns with regard to possible side effects. By contrast, in patients with a diagnosis of diabetic macular oedema (DME) at the time of cataract surgery, intravitreal therapy, both with anti-VEGF drugs and steroids, appears to be the best approach in order to control PME and achieve a good visual outcome. CONCLUSION All diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PME. Intravitreal anti-VEGF drugs and steroids, combined with cataract surgery, should be reserved for patients with preexisting DME.
Collapse
Affiliation(s)
- Francesco Boscia
- aDepartment of Surgical, Microsurgical and Medical Sciences, Ophthalmology Unit, University of Sassari bAzienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | | | | | | |
Collapse
|
|
47
|
Rajavi Z, Safi S, Javadi MA, Azarmina M, Moradian S, Entezari M, Nourinia R, Ahmadieh H, Shirvani A, Shahraz S, Ramezani A, Dehghan MH, Shahsavari M, Soheilian M, Nikkhah H, Ziaei H, Behboudi H, Farrahi F, Falavarjani KG, Parvaresh MM, Fesharaki H, Abrishami M, Shoeibi N, Rahimi M, Javadzadeh A, Karkhaneh R, Riazi-Esfahani M, Manaviat MR, Maleki A, Kheiri B, Golbafian F. Diabetic Retinopathy Clinical Practice Guidelines: Customized for Iranian Population. J Ophthalmic Vis Res 2016; 11:394-414. [PMID: 27994809 PMCID: PMC5139552 DOI: 10.4103/2008-322x.194131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population. METHODS Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9. RESULTS Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence. CONCLUSION This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.
Collapse
Affiliation(s)
- Zhale Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Azarmina
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Alireza Ramezani
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Dehghan
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Shahsavari
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Behboudi
- Department of Ophthalmology, Gilan University of Medical Sciences, Rasht, Iran
| | - Fereydoun Farrahi
- Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mohammad Mehdi Parvaresh
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Fesharaki
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Abrishami
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Shoeibi
- Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mansour Rahimi
- Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Javadzadeh
- Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Karkhaneh
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Maleki
- Department of Ophthalmology, Al Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
|
48
|
Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery. J Ophthalmol 2016; 2016:7945619. [PMID: 27493795 PMCID: PMC4963569 DOI: 10.1155/2016/7945619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/17/2016] [Accepted: 06/19/2016] [Indexed: 12/17/2022] Open
Abstract
Purpose. To compare the efficacy of perioperative ranibizumab injections on diabetic macular edema (DME) in patients undergoing cataract surgery. Methods. This study included 59 eyes of 59 patients. All patients had advanced cataract with DME and underwent an uneventful phacoemulsification surgery. There were 3 subgroups. The first group received intravitreal ranibizumab injection 2 weeks preoperatively, the second group received intraoperatively, and the third group received 2 weeks postoperatively. Follow-up examinations were performed at 1 week as well as at 1 and 3 months. Results. Baseline visual acuity showed a significant increase in all groups at 1 month. In group 1, compared to baseline value, foveal thickness (FT) increased significantly at 1 month and showed a significant decrease up to month 3. In group 2, FT increased at month 1 and this continued up to month 3. In group 3, FT increased at month 1 and was almost stable up to month 3. There were not any significant differences for visual acuity and FT between the groups. Conclusions. Although intrapostoperative ranibizumab injection for DME seems to be more effective than preoperative injections in patients undergoing cataract surgery, the treatment still needs to be continued following surgery.
Collapse
|
|
49
|
Fogli S, Mogavero S, Egan CG, Del Re M, Danesi R. Pathophysiology and pharmacological targets of VEGF in diabetic macular edema. Pharmacol Res 2016; 103:149-57. [DOI: 10.1016/j.phrs.2015.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 11/08/2015] [Accepted: 11/08/2015] [Indexed: 01/27/2023]
|
|
50
|
Zaidi FH, Ansari E. New treatments for diabetic macular edema. World J Ophthalmol 2015; 5:45-54. [DOI: 10.5318/wjo.v5.i2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/10/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
This work comprehensively reviews the latest treatment options for diabetic macular edema (DME) used in its management and presents further work on the topic. Diabetic retinopathy is an important and increasingly prevalent cause of preventable blindness worldwide. To meet this increasing burden there has recently been a proliferation of pharmacological therapies being used in clinical practice. A variety of medical treatment options now exist for DME. These include non-steroidal anti-inflammatory drugs such as nepafenac, as well as intravitreal steroids like triamcinolone (kenalog). Long-term results up to 7 years after commencing treatment are presented for triamcinolone. Studies are reviewed on the use of dexamethasone (ozurdex) and fluocinolone (Retisert and Iluvien implants) including the FAME studies. A variety of anti-vascular endothelial growth factor (anti-VEGF) agents used in DME are considered in detail including ranibizumab (lucentis) and the RESTORE, RIDE, RISE and Diabetic Retinopathy Clinical Research Network (DRCR.net) studies. Bevacizumab (avastin) and pegaptinib (macugen) are also considered. The use of aflibercept (eylea) is reviewed including the significance of the DA VINCI, VISTA-DME, VIVID-DME and the DRCR.net studies which have recently suggested potentially greater efficacy when treating DME for aflibercept in patients with more severely reduced visual acuity at baseline. Evidence for the anti-VEGF agent bevasiranib is also considered. Studies of anti-tumour necrosis factor agents like infliximab are reviewed. So are studies of other agents targeting inflammation including minocycline, rapamycin (sirolimus) and protein kinase C inhibitors such as midostaurin and ruboxistaurin. The protein kinase C β inhibitor Diabetic Macular Edema Study is considered. Other agents which have been suggested for DME are discussed including cyclo-oxygenase-2 inhibitors like celecoxib, phospholipase A2 inhibitors, recombinant erythropoietin, and monoclonal anti-interleukin antibodies such as canakinumab. The management of DME in a variety of clinical scenarios is also discussed - in newly diagnosed DME, refractory DME including after macular laser, and postoperatively after intraocular surgery. Results of long-term intravitreal triamcinolone for DME administered up to seven years after commencing treatment are considered in the context of the niche roles available for such agents in modern management of DME. This is alongside more widely used treatments available to the practitioner such as anti-VEGF agents like aflibercept (Eylea) and ranibizumab (Lucentis) which at present are the mainstay of pharmacological treatment of DME.
Collapse
|