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Central macular thickness (CMT) changes after phacoemulsification in patients with previously treated diabetic retinopathy (DR) and diabetic macular edema (DME)

Session Details

Session Title: Vascular Diseases and Diabetic Retinopathy II

Session Date/Time: Friday 12/09/2014 | 11:00-13:00

Paper Time: 11:40

Venue: Boulevard C

First Author: : V.Dzinic SERBIA

Co Author(s): :    M. Dzinic   A. Oros           

Abstract Details

Purpose:

to investigate the effects of cataract surgery - phacoemulsification in patients with diabetic retinopathy (DR) and diabetic macular edema (DME), who were previously treated with anti-VEGF (bevacizumab) or laser photocoagulation (LFC).

Setting:

Clinical centre Vojvodine, Novi Sad, Serbia Private Eye centre Dzinic

Methods:

during 12 months period 18 patients (22 eyes) were followed. Eight male and ten female, visual acuity (VA) ranges between 0.1 to 0.4 (Snellen chart) and nuclear hardness from N+1 to N+3. Treatment of DR and DME was conducted et least 6 months prior to cataract surgery. Visual acuity (VA) testing (Snellen chart), biomicroscopy, ophthalmoscopy, IOP and SD-OCT (central macular thickness) were conducted at baseline and follow up visits. In all patients despite the treatment neither of the macula was completely “dry”. Uncomplicated coaxial 2.75mm phacoemulsification technique was performed with single piece hydrophilic acrylic lenses implantation. All patients used local non-steroid anti-inflammatory therapy (NSAID) 4-6 weeks before the surgery and continued up to three months after. Follow up visits were conducted at the first and 7th day after the surgery and every 4-6 weeks after. Patients with increased CMT one month after the surgery, were treated with two triamcinolone ( 20 mg ) peribulbar injection, 4 weeks apart. Patients with persistent macular oedema more than three months, were retreated with ant-VEGF and/or LFC based on fluorescein angiography. Last follow up visit was 12 months after the surgery.

Results:

Mean VA before treatment was 0.2 ± 0.16 and average macular thickness 245±45µm. After one month, average macular thickness was 325±75µm and mean VA 0.34±0.24. There months after the surgery average VA was 0,42 ± 0.32 and macular thickness 285±79µm. Three months after the surgery 6 (27%) eyes were retreated with anti-VEGF or LFC. At the last follow up, 12 months after the surgery average CMT was 233±65µm and average VA was 0,43 ± 0.35. Visual acuity improvement was achieved in 18 eyes (82%) and in 4 eyes (18%) stayed at the pre-surgical level.

Conclusions:

According to our study phacoemulsification deteriorate macular stability in previously treated diabetic patients, without completely “dry” retina. Transitional increase in macular thickness, one month after the surgery, was observed in almost all patients. In our study 6 eyes (27%) needed additional anti-VEGF or LFC treatment in order to return CMT to pre surgical level. Despite longer recovery period and additional therapy cataract surgery has beneficial effect on visual acuity in diabetic patients.

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