VIENNA — Most diabetic patients can benefit from modern cataract surgery as much as people without diabetes, unless pre-existing diabetic macular edema is present, according to one specialist.
“Most of us have been raised with the ETDRS recommendations to perform, after cataract extraction, panretinal laser photocoagulation in patients with severe nonproliferative diabetic retinopathy and focal grid laser for patients with macular edema. We were in the 1980s and treated patients with the techniques of those days,” Morten la Cour, MD, said at the meeting of the European Society of Ophthalmology.
Morten la Cour
With modern minimally invasive cataract surgery, the risk of developing DR or DME after cataract surgery is low, provided that no previous proliferative DR or macular edema are present. Poor visual outcomes may be correlated to poor metabolic control rather that surgical trauma, he said.
If DME is already present, on the other hand, it tends to persist or worsen in the postop period, due to the same mechanism that tends to produce cystoid macular edema as a complication.
“It is, as a matter of fact, difficult to differentiate between the two,” la Cour said.
Gains in best corrected visual acuity are limited without further intervention, and treatment is necessary. Anti-VEGFs, steroids and NSAIDs are the options available, but there are currently no evidence-based guidelines for their use. The PREMED European study is underway and will shed light on optimal treatment. — by Michela Cimberle
Disclosure: La Cour reports no relevant financial disclosures.