Assessment of Systemic and Ocular Risk Factors for The Progression of Diabetic Retinopathy Following Cataract Surgery

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

Journal Title

Investigative Ophthalmology and Visual Science

Department

Ophthalmology

Abstract

Purpose : Cataract surgery has been known to worsen the progression of diabetic retinopathy (DR), including development of Proliferative diabetic retinopathy (PDR) and its complications. Previous reports explored this relationship and associated systemic risk factors, but studies on ocular factors associated with such progression have been limited. We performed a retrospective study to assess baseline clinic characteristics associated with progression of DR in patients following cataract surgery. Methods : We conducted a retrospective cohort study consisting of 175 consecutive eyes of 130 diabetic patients undergoing cataract surgery at Westchester Medical Center, Valhalla, NY, between January 2016 and August 2021 with a follow-up period of at least 3 months. Patients had to be at least 18 years old at the time of surgery and were excluded if they had other retinal pathology or uveitis. Patients were assessed for progression as defined by onset or advancement in non-proliferative DR (NPDR) stage, onset of PDR, or development of new neovascular complications on the first 6 months of postoperative follow up. Baseline ocular and systemic factors were compared between patients with documented progression and no progression using chi-square test for categorical variables and non-paired Student's t-test for continuous variables. Results : Seventeen out of 175 eyes presented with progression. All the eyes that progressed had DR at baseline. We found that younger age, insulin use, history of anti-VEGF use, history of diabetic macular edema (DME), previous pars plana vitrectomy and panretinal photocoagulation were associated with DR progression. Intraoperative posterior capsule rupture or iris manipulation were not associated with DR progression. Within the group of patients with DR at baseline, the stage of DR (mild, moderate or severe NPDR or PDR) was not associated with progression, and history of DME was the only ocular factor that remained statistically significant as a risk factor (P=0.048). Conclusions : Progression only happened in patients with DR at baseline, and among those, having a history of DME was associated with increased risk. Our findings may assist in identifying patients who require more intensive pre and postoperative surveillance and treatment, as well as in better directing the focus of prospective studies on this subject. (Figure Presented).

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