Occurrence and progression of diabetic retinopathy after phacoemulsification cataract surgery

PURPOSE: To evaluate the risk factors associated with the occurrence and progression of diabetic retinopathy (DR) after phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. METHODS: The medical charts of 52 eyes of 48 consecutive patients who had phacoemulsification were retrospectively reviewed. The occurrence of DR (new development of any DR) and progression (DR requiring laser treatment) were correlated with patients' age, sex, duration of diabetes, control of diabetes, hypertension, ischemic heart disease, and surgical technique. Exclusion criteria were significant ocular conditions and a follow-up shorter than 6 months. RESULTS: The occurrence of DR was associated with male sex, and among males, with the duration of the disease. An analysis including all patients showed that postoperative progression of preexisting DR was not associated with any factor except poor blood sugar control. Neither the occurrence nor progression of DR was associated with reduced visual acuity CONCLUSIONS: The occurrence and progression of DR after phacoemulsification were associated with different factors. Poor systemic control of diabetes increases the risk.     

Photic maculopathy after extracapsular cataract surgery. A prospective study.

Photic retinal injuries have been described after surgical exposure to the intense illumination systems of operating microscopes. The overall incidence of such injuries has been postulated at less than 10%. The authors prospectively studied 43 consecutive patients to determine the incidence of photic macular injuries during cataract surgery. Patients underwent complete ophthalmic examinations, fundus photography, and oral fluorography before and after surgery. Photic macular injuries developed in 12 of 43 eyes (28%) as a result of intraocular surgery. This incidence is much higher than previous estimates. The association with possible risk factors, cystoid macular edema, and the effect of these injuries on final visual acuity are discussed.     

Inflammation after phacoemulsification in patients with type 2 diabetes mellitus without retinopathy: Prospective study

Purpose:To evaluate inflammation after clear corneal incision (CCI) cataract surgeryin patients with noninsulin-dependent diabetes mellitus and no retinopathy.Methods:Forty patients with diabetes and 40 age-matched controls had standardized temporal CCI cataract surgery with implantation of a foldable intraccular lens. Anterior chamber flare was evaluated in an undilated eye with a laser flare-cell meter preoperatively and 1, 3, 7, 14; and 28 days postoperatively.Results:In both groups, flare and cell values increased on the first postoperative dayand successively decreased on the following days. Flare had not recovered to preoperative values by day 28. At no time was there a significant mean difference in cell and flare between the 2 groups.Conclusion:It does not appear necessary to alter the postoperative therapeuticregimen in patients with type 2 diabetes mellitus and no retinopathy.     

Photic retinopathy after cataract surgery in diabetic patients

PURPOSE: To report and emphasize photic retinopathy (PR) after cataract surgery in diabetic patients. METHODS: The charts of 2,573 patients who underwent cataract surgery at Baskent University Hospital (Ankara, Turkey) between January 2001 and December 2003 were retrospectively analyzed for PR and diabetes mellitus (DM). All surgeries were performed using the same coaxial illuminated microscope. The diagnosis of PR was confirmed by fluorescein angiography, showing typical mottled fluorescein transmission in a well circumscribed area in each case. Statistical analyses were performed with chi2 and Mann-Whitney U tests. RESULTS: Diagnoses of PR and DM were established in 16 cases (0.62%) and 382 cases (14.85%), respectively. DM was present in 7 (43.75%) of the PR cases. PR occurred more frequently in DM patients than in non-DM patients (7/382 vs. 9/2,191, respectively; P = 0.001; chi2= 10.64). All 16 patients with PR had received retrobulbar anesthesia (RA). RA was used in 61.21% of all surgeries and in 78.01% of the surgeries for DM patients. Occurrence of PR during RA was higher for DM patients than for non-DM patients (7/298 vs. 9/1,277, respectively; P = 0.011; chi2= 6.50). Mean operation times +/- SD for PR cases were 29.9 +/- 9.9 minutes and 38.2 +/- 5.3 minutes in DM and non-DM cases, respectively (P = 0.091). None of the photic lesions were sight threatening. CONCLUSIONS: Diabetic patients may be more vulnerable to photic injury. Surgeons should take precautions to prevent PR when performing cataract surgery on diabetic patients.     

Central retinal thickness changes and visual outcomes following uncomplicated small-incision phacoemulsification cataract surgery in diabetic without retinopathy patients and nondiabetic patients

ObjectiveTo compare the visual outcomes and central retinal thickness (CRT) 1 week, 2 weeks, and 4 weeks after surgery in diabetic patients without retinopathy and nondiabetic patients. The relationships between glycated hemoglobin (HbA1c) and visual outcomes and changes in CRT were also evaluated.MethodsPatients who underwent uncomplicated phacoemulsification cataract surgery were enrolled from May 2009 to December 2010, excluding those with preoperative retinal diseases. CRT and best-corrected visual acuity were obtained preoperatively and at 1 week, 2 weeks, and 4 weeks.ResultsThere were 101 eyes in the nondiabetic group and 58 eyes in the diabetic without retinopathy group. There was no difference in preoperative CRT between the two groups. A significant increase in thickness was observed at postoperative Week 4 (p < 0.001) in both groups. However, there were no significant differences in CRT and best-corrected visual acuity before surgery and in all postoperative periods between the groups. In the diabetic without retinopathy group, CRT and visual outcomes were not statistically related to HbA1c level at any time point.ConclusionThere were no significant differences in improvements in postphacoemulsification CRT and visual outcomes between the groups. In the diabetic without retinopathy group, the visual outcomes and CRT were not related to the level of HbA1c. Therefore, as long as there is no diabetic retinopathy, the early postoperative visual recovery and central retinal thickness may not be different from patients without diabetes mellitus.     

上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究 2.血糖稳定的患者中糖尿病视网膜病变进展的危险因素研究

背景 在一些血糖控制良好的糖尿病患者中,仍然可观察到糖尿病视网膜病变(DR)的发生或发展.关于蒙古人种DR进展的危险因素目前尚不完全明确. 目的 了解血糖稳定控制的2型糖尿病患者中DR进展的5年发生率,探讨其危险因素. 方法 采用前瞻性研究设计.纳入2007-2012年上海市新泾社区中糖化血红蛋白(HbA1c)＜7.0％的2型糖尿病患者453例.其中2007年为基线调查阶段,2012年为终末调查阶段,每年对该人群进行检查,包括一般资料的收集、全身体格检查、实验室检查和眼科检查.采用Forward Logistic逐步回归和Cox逐步回归筛选分析DR进展的独立影响因素.采用Kaplan-Meier生存分析法比较不同HbA1c水平患者人群DR进展的发生率. 结果 453例血糖稳定控制的2型糖尿病人群中,5年后DR进展者146例,占32.23％.多元Logistic回归结果显示,基线调查时HbA1c是影响DR进展的独立影响因素[P＜0.01,优势比(OR)=2.84,95％可信区间(CI):2.11 ～3.82].Cox回归分析显示,基线调查时HbA1c≥5.2％人群中DR的发生率比HbA1c＜5.2％的人群升高了1.97倍[P＜0.01,相对危险度(RR)=1.97,95％ CI:1.32 ～2.93].结论 根据现有血糖稳定标准确诊的2型糖尿病人群中,DR进展的发生率仍然较高.建议在不发生低血糖等严重不良反应的前提下,尽量把血糖降到较低水平,从而降低DR进展的发生率.     

Nonproliferative diabetic retinopathy and macular edema progression after phacoemulsification: prospective study

PURPOSE: To determine the incidence of diabetic retinopathy (DR) progression after phacoemulsification in patients with type II diabetes. SETTING: Service of Ophthalmology, University of Sant Joan, Barcelona, Spain. METHODS: This prospective study evaluated 132 patients with diabetes mellitus who had monocular phacoemulsification. A control group comprised the patients' contralateral eyes. Data analysis included preoperative retinal findings and DR status; hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and triglycerides levels; insulin treatment; and arterial hypertension. RESULTS: Postoperative visual acuity increased by 2 or more lines in 105 patients (79.55%); the mean postoperative acuity was 0.63 +/- 0.28 (SD). Diabetic retinopathy in the operated eye progressed in 31 patients (23.48%) and in the fellow eye in 28 patients (21.21%). The progression was associated with high levels of HbA1c and diabetes mellitus duration in both groups. Diabetic macular edema occurred in the operated eye in 8 patients (6.06%) and in the fellow eye in 6 patients (4.54%). Pseudophakic macular edema developed in 2 eyes (1.52%). The progression of diabetic macular edema was not associated with the risk factors studied. CONCLUSION: Uneventful phacoemulsification cataract surgery may not cause DR progression.     

白内障超声乳化术中前房注入头孢呋辛钠后黄斑厚度的测量

目的:了解白内障超声乳化术中前房注入头孢呋辛钠后黄斑厚度的变化。方法:前瞻性临床对照研究。药物组前房内注入头孢呋辛钠,对照组是前房内注入灌注液。入选患者分为4 组: <60岁药物组,<60 岁对照组,≥60 岁药物组和≥60 岁对照组。分别于术前,术后1,6mo 光学相干断层扫描测量黄斑厚度。结果:术后 1mo,≥60 岁药物组在中心凹、内下区、颞内区和外下区区域的厚度大于其他三组。术后 6mo,只有≥60岁药物组的内下区的厚度大于其他三组。术后 1mo,与各自术前的黄斑厚度相比,≥60 岁药物组在中心凹、内下区、颞内区和外下区区域的增加的厚度大于其他三组。术后6mo,≥60 岁药物组的中心凹和内下区的增加的厚度大于其他三组。结论:白内障术后黄斑厚度增加在术后 6mo 尚不能恢复到术前状态。相对于较年轻患者,超过 60 岁的白内障患者在术中使用头孢呋辛钠会在术后1mo 黄斑厚度增加更多。     

2型糖尿病患者白内障术后后囊混浊的临床研究

目的比较合并2型糖尿病的老年性白内障患者与单纯老年性白内障患者行超声乳化白内障摘除人工晶状体植入术后后囊膜混浊情况。方法2001年3月至2003年3月于我院行超声乳化白内障摘除人工晶状体植入术162例(145只眼)。其中,合并2型糖尿病的老年性白内障患者80例(120只眼)为A组;单纯老年性白内障患者82例(125只眼)为B组。随访时间3~36个月,比较两组后囊膜混浊发生率、后囊膜混浊程度及YAG激光后囊切开百分率。结果A组、B组后囊膜混浊百分率分别为50.00%、26.04%;YAG激光后囊切开百分率分别为20.00%、6.04%,两种百分率差异均有显著性(P<0.01)。两组后囊膜混浊程度分级后行秩和检验差异有显著性(P<0.01)。结论2型糖尿病是影响白内障术后后囊膜混浊的重要因素。     

The natural history of macular edema after cataract surgery in diabetes

OBJECTIVE: To determine the natural history of macular edema after cataract surgery in diabetes to provide a rational basis for laser therapy. DESIGN: Prospective clinical and angiographic trial. PARTICIPANTS: Thirty-two patients with diabetes undergoing cataract surgery. INTERVENTION: Phacoemulsification surgery with intraoperative fluorescein angiography, and postoperative clinical and angiographic assessment without macular laser therapy for 1 year after surgery. MAIN OUTCOME MEASURES: Clinically significant macular edema, postoperative macular and optic disc hyperfluorescence relative to the intraoperative angiogram, and logarithm of the minimum angle of resolution (LogMAR) visual acuity. RESULTS: In the first postoperative year, macular fluorescence remained at its intraoperative level in 2 (6%) of 32 eyes and increased in 30 (94%) of 32 eyes, returning to its intraoperative level within 1 year of surgery in 13 (43%) of 30 eyes. Optic disc fluorescence remained at its intraoperative level in 2 (6%) of 32 eyes, was not graded in 3 (9%) of 32 eyes, and increased in 27 (84%) of 32 eyes, returning to its intraoperative level within 1 year of surgery in 19 (70%) of 27 eyes. Clinically significant macular edema was identified in the first postoperative year in 18 (56%) of 32 eyes, being present at the time of surgery in 5 eyes and arising de novo within 1 year of surgery in 13 eyes. It resolved spontaneously within 1 year of surgery in 0 of 5 eyes in which it had been present at the time of surgery and in 9 (69%) of 13 eyes in which it arose in the first 6 months after surgery (P = 0.05). Angiographic and clinical resolutions of macular edema were less likely in eyes with more severe retinopathy at the time of surgery (P = 0.03, 0.005). One-year LogMAR acuity of 0.3 or less (> or = 20/40) was achieved in 27 (84%) of 32 eyes. Clinically significant macular edema at the time of surgery was associated with poorer 1-year visual acuity in multivariate analysis (P = 0.005, r2 = 0.5). CONCLUSIONS: Clinically significant macular edema present in diabetic eyes at the time of cataract surgery is unlikely to resolve spontaneously, but clinically significant macular edema arising after surgery commonly resolves, particularly if retinopathy is mild. These findings have implications for the timing of cataract surgery in diabetes and postoperative macular laser therapy. Ophthalmology 1999;106:663-668     

老年糖尿病患者白内障术后视网膜病变的连续观察

目的评价白内障超声乳化摘出联合人工晶状体植入术后老年糖尿病患者的视力效果及视网膜病变的进展状况。方法对179例179眼老年糖尿病白内障患者行超声乳化白内障摘出联合人工晶状体植入术。术后对术眼及对侧非手术眼视网膜病变进行比较。结果术后最佳矫正远视力≥0．5者159眼，其中无糖尿病视网膜病变者78眼，单纯性糖尿病视网膜病变者80眼，增生性糖尿病视网膜病变者1眼；视力结果取决于视网膜病变特别是黄斑病变程度。术眼中79眼、非手术眼中27眼出现视网膜病变进展，表现为视网膜内出血，火焰状出血斑，硬性及棉絮状渗出斑不同程度的增多，视网膜水肿，黄斑病变加剧及进一步的新生血管形成。结论（1）早期手术效果好，与非糖尿病老年白内障术后无明显差别；（2）晚期手术效果差，白内障手术可加速糖尿病视网膜病变进展；（3）早期手术可提高视力，便于眼底观察及激光治疗。[眼科新进展2007；27（2）：140-141]     

糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的分析

目的　观察糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿情况并分析其部分原因。方法　本研究为前瞻性研究,对在北京大学第三医院眼科中心行常规白内障超声乳化的糖尿病患者分别在术前及术后１个月、３个月时行相关检查并对结果进行统计学分析。结果　共６５例９６眼纳入数据分析。术后１个月、３个月视力分别为（０．０８±０．１３）ＬｏｇＭＡＲ和（０．０７±０．１１）ＬｏｇＭＡＲ,均较术前的（０．５９±０．１８）ＬｏｇＭＡＲ明显升高（均为Ｐ＜０．００１）。黄斑中心厚度术前为（２５３．６±２９．２）μｍ,术后１个月时增加至（２７７．１±１００．２）μｍ（Ｐ＝０．００８）,术后３个月时增加至（２７５．０±９４．１）μｍ（Ｐ＝０．０１０）,而黄斑内环区视网膜厚度则从术前的（３２１．３±２５．０）μｍ分别增加至术后１个月的（３４２．１±６５．６）μｍ（Ｐ＜０．００１）和术后３个月的（３４７．７±８０．０）μｍ（Ｐ＜０．００１）,黄斑外环区视网膜厚度则从术前的（２７８．８±１９．９）μｍ增加至术后１个月的（２８８．６±５０．１）μｍ（Ｐ＝０．０２５）和术后３个月的（２８９．６±５４．１）μｍ（均为Ｐ＝０．０２５）。黄斑容积从术前的（１０．１１±０．７３）ｍｍ３增加至术后１个月的（１０．６５±２．３１）ｍｍ３（Ｐ＝０．００６）和术后３个月的（１０．７３±２．４４）ｍｍ３（Ｐ＝０．００３）。术前共２２眼存在糖尿病性黄斑水肿（ｄｉａ-ｂｅｔｉｃｍａｃｕｌａｒｅｄｅｍａ,ＤＭＥ）,其中中心型ＤＭＥ２眼,非中心型ＤＭＥ１４眼,弥漫型ＤＭＥ６眼。不同ＤＭＥ分组术后１个月及３个月的黄斑中心厚度均值及改变量存在显著差异（均为Ｐ＜０．０５）。患眼术后的黄斑中心厚度与术前糖尿病视网膜病变的严重程度相关（１个月时ｒ＝０．３３１,Ｐ＝０．００１;３个月时ｒ＝０．３１８,Ｐ＝０．００２）。但糖尿病病程长短及术前是否行激光治疗与术后黄斑中心厚度无明显相关性。结论　糖尿病患者行常规白内障超声乳化术后有出现黄斑水肿的可能性,患者术后的黄斑水肿程度与术前黄斑水肿的类型以及术前糖尿病视网膜病变严重程度均相关。     

Visual outcome and progression of retinopathy after cataract surgery in diabetic patients

Purpose: Diabetes mellitus is a major cause of visual impairment in developed countries through retinopathy and is frequently complicated by cataract formation. The present study examines the visual outcome of cataract surgery in diabetic patients.
Methods: A retrospective study was performed over a 26 month period in a general hospital eye clinic. Eighty-five consecutive diabetic patients who underwent cataract surgery were categorized according to their type of diabetes, duration and treatment, operative technique, pre-operative visual acuity (VA) and degree of retinopathy. Visual acuity and retinopathy status were recorded at a minimum of 4 months postoperatively. Factors affecting visual outcome and progression of retinopathy were then examined.
Results: Of the 107 eyes of the 85 consecutive cases, 55 were without retinopathy (NR), 21 had background retinopathy (BDR), six had background retinopathy with macular oedema (BDR/MO), four had proliferative retinopathy and 12 cases had inadequate fundal view. In the NR and BDR groups, 90 and 81% of patients, respectively, had improved VA compared with 33% of patients with BDR/MO. Retinopathy progressed in 50% of BDR/MO patients compared with progression in 9 and 19% of NR and BDR patients, respectively.
Conclusion: The present study illustrates the poor visual outcome in patients with severe, untreated retinopathy, particularly maculopathy, following cataract surgery. Larger prospective studies are needed to better define risk groups and pre-operative treatment strategies.     

2型糖尿病白内障术后后囊混浊的临床研究

目的比较合并2型糖尿病的老年性白内障患者与单纯老年性白内障患者行超声乳化白内障摘出人工晶状体植入术后后囊膜混浊情况。方法2001年3月～2003年3月我院行超声乳化白内障摘出人工晶状体植入术162例245眼，A组为合并2型糖尿病的老年性白内障患者80例120眼，B组为单纯性老年性白内障患者82例125眼。随访3～36个月，比较2组PCO发生率及YAG激光后囊切开百分率、囊膜混浊程度。结果A组、B组后囊膜混浊百分率分别为50．00％、26．04％；YAG激光后囊切开百分率分别为20．00％、6．04％，2种百分率差异均有显著性（P〈0．01）。2组后囊膜混浊程度分级后行秩和检验，差异有显著性（P〈0.01）。结论2型糖尿病是影响白内障术后后囊膜混浊的重要因素之一。     

Population-based study of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan

BACKGROUND: The purpose of this study was to assess the prevalence and associated factors of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan. METHODS: A community-based population survey between 1991 and 1993 identified 971 patients over the age of 30 years with type 2 diabetes. In 1999, a total of 578 patients (59.5%) with type 2 diabetes from the population were examined in an ophthalmic screening study. Two senior ophthalmologists employed slit-lamp biomicroscopy, indirect ophthalmoscopy, and retinal photographs with pupil dilatation to examine the patients' lenticular and retinal status. RESULTS: The prevalence of cataract surgery in one eye, both eyes, and any cataract surgery among patients with type 2 diabetes was 4.5%, 5.4%, and 9.9%, respectively. The prevalence of cataract surgery in women (11.3%) was not significantly higher than in men (7.7%), but there was a statistical increase with age (p = 0.001, chi2 trend test). Multiple logistic regression showed that age (OR 1.13, 95% CI 1.07-1.19) and diabetic retinopathy (OR 4.68, 95% CI 1.94-11.33) were independent factors associated with cataract surgery. INTERPRETATION: Age and diabetic retinopathy were associated with prevalence of cataract surgery among persons with type 2 diabetes.     

1型与2型糖尿病患者增生型糖尿病视网膜病变的玻璃体手术疗效比较

目的 观察1、2型糖尿病(DM)对玻璃体视网膜手术治疗增生型糖尿病视网膜病变(PDR)疗效的影响。 方法 回顾分析1999年6月至2003年10月期间451例因PDR接受玻璃体视网膜手术治疗的DM患者的临床资料，其中1型71例,2型380例。手术后至少随访14个月，平均随访时间29个月。通过两组患者视力、虹膜新生血管(INV)发生与消退、新生血管性青光眼(NVG)发生与消退、视网膜在位率和复位率等观察指标的比较，观察DM不同分型对PDR患者玻璃体视网膜手术治疗效果的影响。 结果 手术前1型DM患者中Ⅵ期PDR、视力在0.1以下眼、INV、NVG等严重PDR眼病变的比例均高于2型DM患者。手术治疗后视力提高者的比例，1型DM患者中占64.8%，2型DM患者中占72.4%(P=0.196)；1型DM患者PDR合并虹膜红变眼75.0%手术后虹膜红变消退,而2型患者中这一比例为60.0%(P=0.678)；手术后新增虹膜红变眼的比例,1型DM患者为6.3%,2型DM患者为5.6%(P=0.822）。无论是1型还是2型DM患者NVG眼压都得到有效控制,仅1例1型DM患者的INV未消退；手术前存在视网膜脱离的 PDRVI期患者中，一次手术后视网膜复位率1型DM患者为87.2%,2型DM患者为89.8%(P=0.611)。一次手术后视网膜保持在位率，1型DM患者为90.1%，2型DM患者为93.4%(P=0.323)。 结论 PDR患者的DM分型对玻璃体视网膜手术治疗的效果没有明显影响。(中华眼底病杂志,2007,23:248-251)     

上海市新泾社区2型糖尿病患者5年随访的前瞻性调查研究3.糖尿病视网膜病变和糖尿病黄斑水肿的好转及促进因素

背景 对2型糖尿病患者的长期随访过程中发现,部分糖尿病视网膜病变(DR)和糖尿病黄斑水肿(DME)患者未经眼底激光光凝、内眼手术或眼内药物治疗眼底病变可好转,但其影响因素尚不清楚.目的 探讨中国2型糖尿病患者DR和DME自行好转的发生率及促好转影响因素. 方法 采用前瞻性观察研究方法,于2007-2012年对上海市新泾社区中符合纳入标准的778例2型糖尿病患者进行连续5年的流行病学调查和随访,收集患者一般资料,对患者行全身体格检查、实验室血生化指标检查、眼部检查和眼底照相,眼底照片读片采用盲法.采用国际临床分类方法和视网膜玻璃体增生情况将DR分为无明显DR和轻、中、重度非增生性DR及增生性DR;并将DME分为无、轻度、中度和重度DME.将DR好转和DME好转作为2个结局变量,好转为仅接受全身用药者至少一眼终末DR或DME分级较基线时下降至少1级且对侧眼DR无进展.采用Logistic多元回归分析判断年龄、性别、受教育程度、糖尿病发病年龄、糖尿病病程、肥胖及血肌酐、三酰甘油、总胆固醇和糖化血红蛋白(HbA1c)水平对结局变量的影响.结果 2007年基线调查时发现DR患者456例,其中139例患者5年后至少1眼DR好转,好转率为30.48％.基线检查低HbA1c水平和低血肌酐水平是DR好转的促进因素[HbA1c:优势比(OR)=0.53,95％可信区间(CI)]:0.45 ～0.63,P＜0.01;血肌酐:OR=0.98,95％ CI:0.97 ～0.99,P＜0.01).基线调查时发现DME 158例,其中20例5年后至少1眼好转,好转率为12.66％.高基线血糖水平是DME好转的唯一、独立影响因素(OR=1.47,95％ CI:1.14～1.91,P＜0.01).结论 降低2型糖尿病DR患者的血糖和血肌酐水平有助于DR好转,快速降低血糖水平有助于DME的好转.