Phacoemulsification cataract surgery combined with prophylactic intravitreal bevacizumab is an effective treatment in the short term in patients with coexisting diabetic retinopathy, according to a systematic review and meta-analysis of published data.
Cataract surgery in patients with diabetic retinopathy (DR) is known to accelerate the progression of DR and exacerbate diabetic macular edema. The purpose of the study was to assess whether intravitreal bevacizumab (IVB) might prevent or mitigate the effects of surgery in these patients.
Through systematic searches of PubMed, EMBASE and the Cochrane Controlled Trials Register, the authors identified six comparative randomized controlled or cohort studies, including a total of 283 eyes, comparing cataract surgery with and without simultaneous IVB therapy in patients with DR. Outcome measures were the mean change in corrected distance visual acuity (CDVA) from baseline, mean change in central macular thickness (CMT), progression of postoperative DR and diabetic maculopathy after surgery.
Results showed a significantly thinner CMT in patients who underwent cataract surgery in combination with intravitreal bevacizumab compared to the control group at 1, 3 and 6 months postoperatively.
The IVB group showed better results in CDVA than the control group after 1 and 3 months post-op. However, no difference was found between the two groups in terms of CDVA at 6 months.
At 6 months, the rate of progression of diabetic retinopathy and maculopathy in the IVB groups was 9.7% (14 out of 144 eyes) and 6.5% (four out of 62 eyes) respectively, compared to 39.5% (45 out of 114 eyes) and 50.8% (32 out of 63 eyes) in the control groups. No severe ocular or systemic adverse effects related to bevacizumab injection were reported.
“Our data suggest that cataract surgery combined with IVB for patients with DR seems to be an effective and safe treatment in the short term at least. Therefore, more randomized, prospective, and large sample–sized studies are needed to evaluate the long-term effects of intravitreal anti-VEGF therapy at the time of cataract surgery in patients with DR,” the authors concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.