CATARACT SURGERY AND PROGRESSION OF DIABETIC RETINOPATHY

Abstract

Patient with diabetes mellitus have a higher prevalence of lens opacity
1
and cataract
development at an earlier age than non diabetic.
2
Cataract in diabetes mellitus decreases
the visual acuity, makes posterior segment evaluation and laser treatment difficult.
Several studies have shown that there is progression of diabetic retinopathy after cataract
surgery. In all studies, criteria for progression of diabetic retinopathy are:
a) progression of any form/type or stage of diabetic eye (DE), nonproliferative diabetic
retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) to any advanced,
recurrent form/ type or stage of NPDR or PDR and
b) development of new clinically significant macular edema (CSME) and/or worsening/
recurrent of preexisting CSME defined by Early Treatment Diabetic Retinopathy
Study (ETDRS).
• More severe the preexisting diabetic retinopathy (DR), much worse the DR after
cataract extraction. The progression of DR after cataract extraction is severe in
Intracapsular Cataract Extraction (ICCE) than Extracapsular Cataract Extraction
(ECCE) with Intraocular Lens (IOL) and Sutureless Small Incision Cataract
Surgery (SICS) and Phacoemulcification.
• Progression of DR increases with complicated cataract surgery, like posterior
capsular rupture (PCR), vitreous loss and prolonged surgery.
• The first 6 months period is crucial as a minimum period of follow up to detect
progression of DR.
• There are other several local and systemic risk factors for the progression of DR,
like hypertension, renal failure, ischemic heart disease, high cholesterol and
triglyceride level, pregnancy etc.

Key Words: Diabetic retinopathy, cataract surgery, risk factors