Cataract surgery should not be delayed based on the HbA1c levels in patients with diabetic eye disease.
A recent study of outcomes after cataract surgery indicated that patients with diabetic retinopathy (DR) with no previous macular disorders achieved 20/20 vision, and the line gain was the same as patients without diabetes who underwent cataract surgery, according to Geraldine R. Slean, MD, MS.
The investigators conducted a retrospective cohort study that included patients at Kaiser Permanente Northern California who presented for cataract surgery from June 2010 to May 2015. Patients were enrolled for at least 1 year before surgery.
Patients were excluded who had macular edema preoperatively or type 1 diabetes, had undergone cataract surgery by a retina or oculoplastics specialist, or if endophthalmitis was diagnosed within the previous year.
The study included 102,050 eyes of 65,370 patients who underwent uncomplicated phacoemulsification. Best-corrected visual acuity (BCVA) had been recorded up to 1 year preoperatively.
The earliest postoperative BCVA was measured between 3 weeks to 1 year postoperatively, said Dr. Slean, who is an ophthalmology resident, California Pacific Medical Center, San Francisco, and will be joining Kaiser Permanente upon graduation.
Of the total number of patients, 22,360 (34%) of the study patients had diabetes; 81% had diabetes without DR, 15% had diabetes with nonproliferative diabetic retinopathy (NPDR) of varying severities, and 4% had diabetes with PDR. The duration of diabetes was less than 10 years in 37% and 10 years or longer in 41%.
Insulin was used by 20% of patients. Only 41% of patients obtained a hemoglobin A1C (HbA1c) measurement 90 days preoperatively; of these, 13% had a HbA1c value of <6.5%, 25% from 6.5 to 8.9%, and 4% 9.0%, she noted.
Geraldine R. Slean, MD, MS.
E: [email protected]
Dr. Slean has no financial interest in any aspect of this report. She was joined in this study by Liyan Liu, MD; Lisa Herrinton, MD; Stacey Alexeeff, MD; Andrew Karter, MD; Laura Amsden, MD; James Carolan, MD; and Neal Shorstein, MD.