Measuring HbA1c levels before cataract surgery can help assess the risk for a patient with diabetes developing cystoid macular edema after cataract surgery, according to a study.
The prospective study included 93 patients, seven with type 1 diabetes and 86 with type 2 diabetes, who were scheduled for cataract surgery. The mean duration of diabetes was 14.8 years. Thirty-five patients were insulin dependent. Patient age, HbA1c concentration, topical and system medications, presence of diabetic maculopathy and age-related macular degeneration, intravitreal treatment and surgery were recorded.
A significant association was found between HbA1c concentration, reflecting poor glycemic control, and retinal thickness increase. Younger age and insulin dependence were also correlated with greater thickness changes. Conversely, NSAID use was correlated with less retinal thickness increase.
“The HbA1c, a simple quantitative measure, might be used as one of the tools to estimate an individual’s risk for developing pseudophakic CME,” the authors suggested.
They noted that the mechanism behind the correlation between poor glycemic control and increased retinal thickness is probably multifactorial and might include inflammatory and vasoactive factors, microvascular dysfunction and breakdown of the blood-retinal barrier.
These findings confirm that poor glycemic control increases the risk for CME and further highlight the importance of strict diabetes management, particularly before patients undergo cataract surgery. They also provide useful suggestions for selecting patients who might benefit from the use of anti-inflammatory medications, topical NSAIDs in particular, postoperatively and perhaps preoperatively, alone or in combination with corticosteroids.
“These results facilitate the evaluation of any diabetic cataract patient’s risk for postoperative complications. With knowledge of patient’s glycemic control, the operating surgeon can choose anti-inflammatory treatment accordingly,” Petteri Ylinen, MD, lead author of the study, told Healio.com/OSN. – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.