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Morya AK, Nishant P, Ramesh PV, Sinha S, Heda A, Salodia S, Prasad R. Intraocular lens selection in diabetic patients: How to increase the odds for success. World J Diabetes 2024; 15:1199-1211. [DOI: 10.4239/wjd.v15.i6.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/23/2024] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Abstract
The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.
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Affiliation(s)
- Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Prateek Nishant
- Department of Ophthalmology, ESIC Medical College, Patna 801113, Bihar, India
| | - Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Sony Sinha
- Department of Ophthalmology-Vitreo-Retina, Neuro-Ophthalmology and Oculoplasty, All India Institute of Medical Sciences, Patna, Patna 801507, Bihar, India
| | - Aarti Heda
- Department of Ophthalmology, National Institute of Ophthalmology, Pune 411000, Maharashtra, India
| | - Sarika Salodia
- Department of Safety, Global Medical Safety, Lundbeck, Singapore 307591, Singapore
| | - Ripunjay Prasad
- Department of Ophthalmology, RP Eye Institute, Delhi 110001, India
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Pastore MR, Vinciguerra AL, Mura GD, Jabali AE, Tognetto D, Panozzo G. Worsening of early DME after cataract surgery. The DICAT II Study report #2. Eur J Ophthalmol 2024:11206721241245743. [PMID: 38576315 DOI: 10.1177/11206721241245743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE To analyse the long anatomical and functional outcome of a subgroup of the DICAT II study cohort, consisting of 26 patients undergoing cataract surgery and withdrawn from the study for a clinically significant worsening of early diabetic macular edema (DME). MATERIALS Patients who underwent cataract surgery and withdrawn from the DICAT II study for a clinically significant worsening of early DME with at least 12 months follow-up after the dropout. The study population was divided into two groups according to the clinical evaluation at one-year follow-up: ongoing treatment patients for DME (Treatment group, TG) and patients no longer treated (Non Treatment group, NTG). RESULTS Central foveal thickness (CFT) at baseline and dropout time were higher in TG than in the NTG, with a statistically significant difference (p < 0.05). In addition, TG patients reported a higher levels of glycated hemoglobin at time baseline compared to NTG patients (7.81 ± 1.15 vs 7.02 ± 0.56; p = 0.048). The linear regression analysis demonstrated a statistically significant relationship between the visual acuity and the ongoing treatment group at one-year follow-up (p = 0.042). CONCLUSION The study provides parameters to be considered when assessing the risk of developing persistent DME after cataract surgery in diabetic patients. In particular, CFT at baseline and dropout time have been reported to be an effective and predictable OCT biomarkers when evaluating DME progression. During the evaluation of the systemic disease, similar results were found for the glycated hemoglobin at baseline.
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Affiliation(s)
- Marco R Pastore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Abdallah El Jabali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giacomo Panozzo
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Mian OT, Asif H, Sandhu U, Multani K, Farooq AV, Ding K, Riaz KM. Noninfectious Outcomes of Intravitreal Antibiotic Steroid Injection and Topical Nonsteroidal Antiinflammatory Drugs Versus Triple Drop Therapy After Cataract Surgery. Am J Ophthalmol 2024; 260:37-48. [PMID: 37944685 DOI: 10.1016/j.ajo.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To compare noninfectious outcomes of intravitreal antibiotic steroid (IVAS) injection (moxifloxacin-triamcinolone) and postoperative topical nonsteroidal antiinflammatory drugs (NSAID) with a standard 3-drop therapy (TDT) regimen (topical antibiotic, steroid, and NSAID) in patients after cataract surgery. DESIGN Retrospective comparative clinical cohort study. METHODS In 3 study centers in the United States, a total of 2143 eyes (N = 2143 patients) underwent cataract surgery with IVAS-NSAID or TDT between 2017 and 2022. Preoperative data were included, including patients' age, iris color, medical history, and ocular history. Postoperative data, including best-corrected visual acuity, intraocular pressure (IOP), and the need for IOP-lowering medications, were recorded at 1-week, 1-month, and 6-month time points. The primary outcome measures were postoperative complications, defined as persistent anterior chamber inflammation, persistent corneal edema (PCE), rebound inflammation, and cystoid macular edema, were compared between the 2 groups. RESULTS There were 1079 eyes in the IVAS-NSAID group and 1064 eyes in the TDT group. Best-corrected visual acuity and IOP were similar between IVAS-NSAID and TDT eyes at all time points. A portion (11.6%) of TDT eyes experienced postoperative complications compared with 6.5% in IVAS-NSAID eyes (P < .001). Femtosecond laser-assisted cataract surgery was associated with increased rates of PCE in IVAS-NSAID eyes, and eyes with dark irides had a higher incidence of cystoid macular edema, PCE, and rebound inflammation in the IVAS-NSAID group. CONCLUSION The IVAS-NSAID regimen overall had similar postoperative outcomes and fewer complications compared with the TDT regimen. IVAS-NSAID may be considered a safe alternative to topical regimens in non-femtosecond laser-assisted cataract surgery and patients with light irides.
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Affiliation(s)
- Osamah T Mian
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Hassaan Asif
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Umar Sandhu
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Karan Multani
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Asim V Farooq
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Kai Ding
- Department of Biostatistics and Epidemiology (K.D.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kamran M Riaz
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma.
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Cioana M, Patodia Y, Tong L, Chiu HH, Tam ES, Somani S. Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS. J Cataract Refract Surg 2024; 50:160-166. [PMID: 37847109 DOI: 10.1097/j.jcrs.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients. SETTING Outpatient surgical center in Vaughan, Ontario, Canada. DESIGN Prospective cohort study. METHODS Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3). RESULTS Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter. CONCLUSIONS FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes.
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Affiliation(s)
- Milena Cioana
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Cioana); Uptown Eye Specialists, Vaughan, Ontario, Canada (Cioana, Tong, Chiu, Tam, Somani); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Patodia, Tong, Chiu, Tam, Somani); William Osler Health System, Brampton, Ontario, Canada (Tong, Chiu, Tam, Somani); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Chiu)
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Taloni A, Coco G, Rastelli D, Buffon G, Scorcia V, Giannaccare G. Safety and Efficacy of Dexamethasone Intravitreal Implant Given Either First-Line or Second-Line in Diabetic Macular Edema. Patient Prefer Adherence 2023; 17:3307-3329. [PMID: 38106365 PMCID: PMC10725633 DOI: 10.2147/ppa.s427209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients' candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.
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Affiliation(s)
- Andrea Taloni
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Rastelli
- Department of Ophthalmology, Policlinico Casilino, Rome, Italy
| | - Giacinta Buffon
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Gabrielle PH, Mehta H, Barthelmes D, Daien V, Nguyen V, Gillies MC, Creuzot-Garcher CP. From randomised controlled trials to real-world data: Clinical evidence to guide management of diabetic macular oedema. Prog Retin Eye Res 2023; 97:101219. [PMID: 37898362 DOI: 10.1016/j.preteyeres.2023.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023]
Abstract
Randomised clinical trials (RCTs) are generally considered the gold-standard for providing scientific evidence for treatments' effectiveness and safety but their findings may not always be generalisable to the broader population treated in routine clinical practice. RCTs include highly selected patient populations that fit specific inclusion and exclusion criteria. Although they may have a lower level of certainty than RCTs on the evidence hierarchy, real-world data (RWD), such as observational studies, registries and databases, provide real-world evidence (RWE) that can complement RCTs. For example, RWE may help satisfy requirements for a new indication of an already approved drug and help us better understand long-term treatment effectiveness, safety and patterns of use in clinical practice. Many countries have set up registries, observational studies and databases containing information on patients with retinal diseases, such as diabetic macular oedema (DMO). These DMO RWD have produced significant clinical evidence in the past decade that has changed the management of DMO. RWD and medico-administrative databases are a useful resource to identify low frequency safety signals. They often have long-term follow-up with a large number of patients and minimal exclusion criteria. We will discuss improvements in healthcare information exchange technologies, such as blockchain technology and FHIR (Fast Healthcare Interoperability Resources), which will connect and extend databases already available. These registries can be linked with existing or emerging retinal imaging modalities using artificial intelligence to aid diagnosis, treatment decisions and provide prognostic information. The results of RCTs and RWE are combined to provide evidence-based guidelines.
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Affiliation(s)
- Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, Dijon, Burgundy, France; The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Hemal Mehta
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Vincent Daien
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Montpellier University Hospital, Montpellier, France; Institute for Neurosciences of Montpellier, Univ Montpellier, INSERM, Montpellier, France
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Spinetta R, Petrillo F, Reibaldi M, Tortori A, Mazzoni M, Metrangolo C, Gelormini F, Ricardi F, Giordano A. Intravitreal DEX Implant for the Treatment of Diabetic Macular Edema: A Review of National Consensus. Pharmaceutics 2023; 15:2461. [PMID: 37896220 PMCID: PMC10610055 DOI: 10.3390/pharmaceutics15102461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic macular edema (DME)'s therapeutic approach can frequently be challenging. The purpose of the review is to propose evidence-based recommendations on the employment of intravitreal dexamethasone implants (DEX) when approaching patients suffering from DME. Seven national consensuses redacted by different groups of retina specialists from Europe and Asia were examined and confronted. Each consensus was redacted utilizing a Delphi approach, in person meetings, or by reviewing the literature. DEX can be studied as a first-line strategy in individuals suffering from DME with inflammatory OCT biomarkers, in vitrectomized eyes, in patients with recent cardiovascular events, in pregnant women, in patients scheduled to undergo cataract surgery or with poor compliance. The other parameters considered were the indications to the DME treatment, when to switch to DEX, the definition of non-responder to anti-VEGFs agents and to the DEX implant, whether to combine DEX with laser photocoagulation, the association between glaucoma and DEX, and the management of DEX and the cataract. Although several years have passed since the introduction of DEX implants in the DME treatment, there is still not a unified agreement among retina specialists. This paper compares the approach in the DME treatment between countries from different continents and provides a broader and worldwide perspective of the topic.
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Affiliation(s)
| | - Francesco Petrillo
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Michele Reibaldi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonia Tortori
- Ophthalmology Unit, Surgery Department, Piacenza Hospital, 29121 Piacenza, Italy;
| | - Maria Mazzoni
- University Center for Studies on Gender Medicine, University of Ferrara, 44124 Ferrara, Italy;
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy
| | - Cristian Metrangolo
- Ophthalmology Unit, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, 21100 Varese, Italy;
| | - Francesco Gelormini
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Federico Ricardi
- Department of Medical Sciences, Eye Clinic, Turin University, 10024 Turin, Italy; (M.R.); (F.G.); (F.R.)
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA;
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Choi J, Kim SJ, Kang SW, Son KY, Hwang S. Local ocular factors associated with the development of diabetic macular edema: an inter-eye study. Sci Rep 2023; 13:14868. [PMID: 37684395 PMCID: PMC10491578 DOI: 10.1038/s41598-023-42038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023] Open
Abstract
To investigate local ocular factors associated with the development of diabetic macular edema (DME), we classified each eye of patients with unilateral DME as the DME eyes or the fellow eyes (without DME). We compared the clinical characteristics, optical coherence tomography (OCT), and OCT angiography (OCTA), ultra-wide field fundus photography, and angiography features of each eye. As a result, fifty-five patients with unilateral DME were enrolled. Although the diabetic retinopathy stage was not different between each group of eyes, DME eyes showed a higher prevalence of venous beading and a larger area of nonperfusion region than did fellow eyes (all P < 0.05). OCTA features of DME eyes also showed a larger foveal avascular zone in the deep capillary plexus and a lower vascular density in both the superficial and deep capillary plexuses (all P < 0.05). This study highlighted ocular features reflecting retinal ischemia, such as venous beading, area of nonperfusion region, and vascular density in the central retinal area, are associated with the development of DME. OCTA and ultra-wide field fluorescein angiography may be useful for evaluating the parameters of retinal ischemia and the risk of DME development.
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Affiliation(s)
- Jaehwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang Jin Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ki Young Son
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong, South Korea
| | - Sungsoon Hwang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Lai CC, Kuo SC. Real-world experience on intravitreal dexamethasone implant in patients with macular edema scheduled to undergo cataract surgery. BMC Ophthalmol 2023; 23:352. [PMID: 37559002 PMCID: PMC10413593 DOI: 10.1186/s12886-023-03093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Patients with pre-existing macular edema (ME) due to diabetes and retinal vein occlusions (RVO) make up a growing population receiving cataract surgery. Surgery is associated with an increased risk of worsening existing ME due to post-surgical inflammation that can be further exacerbated by pre-existing diabetic retinopathy (DR) and retinal vein occlusion. This study aimed to examine the pre-operative use of intravitreal dexamethasone (DEX) implants in patients with ME undergoing cataract surgery. METHODS A retrospective study was conducted at National Cheng Kung University Hospital in Taiwan involving 19 eyes of 16 patients with DME or ME associated with RVO. All participants received a DEX implant at baseline and underwent phacoemulsification within 3 months after its insertion. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central subfield thickness (CST) were evaluated. RESULTS DEX implants reduced the CST from baseline (357.8 μm) to pre-surgery (280.8 μm). This reduction below baseline continued to month 6 post-surgery (319.4 μm). From baseline (16.15 mmHg), the mean IOP initially increased pre-surgery (17.78 mmHg) before returning to the baseline value at month 6 post-surgery (16.15 mmHg). All patients improved their BCVA from logMAR 0.943 on average at baseline to logMAR 0.532 at month 6 post-surgery. CONCLUSIONS The results of the study suggested that patients with ME could benefit from DEX implants before cataract surgery within 3 months to achieve sufficient postoperative inflammation management and limit ME deterioration. DEX implants did not increase IOP post-surgery and was similar to baseline levels.
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Affiliation(s)
- Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Chun Kuo
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.
- Department of Optometry, Chung Hwa University of Medical Technology, No. 901, Zhonghua Rd, Yongkang District, Tainan City, 710, Taiwan.
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Khalil MMAA, Mansour HO, Tawfik AMR, Elmahdy AG. Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema. BMC Ophthalmol 2022; 22:492. [PMID: 36522705 PMCID: PMC9756666 DOI: 10.1186/s12886-022-02625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation. METHODS Retrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 μm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months). RESULTS After 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030). CONCLUSIONS Combined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.
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Affiliation(s)
| | - Hosam Othman Mansour
- Magrabi Eye Hospital Tanta, Tanta, Egypt ,grid.411303.40000 0001 2155 6022Department of Ophthalmology, Faculty of Medicine, Al Azhar University, Damietta branch, New Damietta, Egypt
| | | | - Ahmed Gomaa Elmahdy
- grid.411303.40000 0001 2155 6022Department of Ophthalmology, Al Azhar University, Cairo, Egypt
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11
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Fallico M, Lotery A, Maugeri A, Favara G, Barchitta M, Agodi A, Russo A, Longo A, Bonfiglio V, Avitabile T, Marolo P, Borrelli E, Parisi G, Cennamo G, Furino C, Reibaldi M. Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis. Eye (Lond) 2022; 36:2239-2246. [PMID: 34795415 PMCID: PMC9674685 DOI: 10.1038/s41433-021-01847-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare outcomes of cataract surgery combined with either anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy or dexamethasone implant (DEX) in patients with diabetic macular oedema (DMO). METHODS Pubmed and Embase databases were searched for studies reporting outcomes of diabetic cataract surgery combined with either anti-VEGF or DEX, with a follow-up ≥3 months. The primary outcome was the mean change in central macular thickness (CMT). Mean change in best corrected visual acuity (BCVA) was considered as a secondary outcome. The mean difference between baseline and post-treatment values (MD) with 95%-Confidence Interval (95%CI) was calculated and meta-analyses were performed. RESULTS Nine-teen studies were included, 8 in the DEX group and 11 in the anti-VEGF group. A significant reduction of macular thickness was shown in the DEX group at 3 months (MD = -98.35 µm; 95% CI, -147.15/-49.54), while mean CMT change was non-significant in the anti-VEGF group (MD = -21.61 µm; 95% CI, -59.46/16.24; test of group differences, P < 0.001). At 3 months, no difference in visual gain was found between the two groups (P = 0.13). CONCLUSIONS In DMO patients, cataract surgery combined with DEX seems to provide better anatomical outcomes compared with cataract surgery combined with anti-VEGF therapy. However, our evidence was limited by significant heterogeneity. Randomised trials comparing these two different combined approaches are warranted.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy.
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Giuliana Favara
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Vincenza Bonfiglio
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, 90127, Palermo, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123, Catania, Italy
| | - Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Enrico Borrelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
| | - Gilda Cennamo
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Claudio Furino
- Department of Ophthalmology, University of Bari, 70124, Bari, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122, Turin, Italy
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12
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Shalchi Z, Angunawela R, Hamilton R. Letter to Editor: Prophylactic Use of Nonsteroidal Anti-Inflammatory Drugs after Cataract Surgery and Corneal Melt. J Curr Ophthalmol 2022; 34:384. [PMID: 36644455 PMCID: PMC9832461 DOI: 10.4103/joco.joco_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/26/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Zaid Shalchi
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom,Address for correspondence: Zaid Shalchi, Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, United Kingdom. E-mail:
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13
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Zaher Addeen S, Shaddoud I. Combined phacoemulsification surgery and intravitreal triamcinolone injection versus stand-alone surgery in patients with type 2 diabetes: a prospective randomized trial. BMC Ophthalmol 2022; 22:445. [PMCID: PMC9675215 DOI: 10.1186/s12886-022-02676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background We would assess the efficacy of intravitreal injection of triamcinolone acetonide IVTA combined with standard phacoemulsification on the central subfield macular thickness (CSMT), the progression of diabetic retinopathy (DR), and the corrected distant visual acuity (CDVA) in type 2 diabetic patients. Methods In this prospective single-blinded randomized clinical trial we recruited patients with type 2 diabetes who were eligible for cataract surgery. The patients were randomly assigned to two groups. The case group received an intravitreal IVTA at the end of phacoemulsification, and the control group had routine surgery. CSMT, progression of DR, CDVA, IOP, and adverse events including endophthalmitis were compared between the groups preoperatively and at 1, 3, and 6 months postoperatively. Results Among a total of 66 patients that were treated within the study period, 50 patients were included in the final analysis. The case group comprised 21 eyes, and the control group included 29 eyes. Regression models and corrected ANOVA test for repeated measures showed a significant reduction in CSMT at 3 and 6 months postoperatively, which was most significant when the preoperative CSMT was ≥300 μm, with a cut-off value of 347.3 μm in the case group (p < 0.000). DR progression was halted in the case group at 6 months with 52.38% of patients having their DR classified as moderate (P = 0.012). CDVA was significantly improved from baseline 6/60 (logMAR 1.0) pre-op to 6/6 (logMAR 0.00) at 6 months post-op in the case group, and from baseline 6/120 (logMAR 1.3) pre-op to 6/12 (logMAR 0.3) at 6 months post-op in the control group. The gain in visual acuity was significantly higher in the case group at all study points (p < 0.001). No significant rise in IOP was observed at any study point in both groups (p = 0.23 > 0.05). No endophthalmitis was recorded. Conclusions Diabetic patients benefit significantly from cataract surgery. This study supports IVTA injection at the end of phacoemulsification in diabetic patients. Triamcinolone is an affordable (which is of particular importance in low-income countries as per our setting), and relatively safe “phaco-enhancer”. Trial registration NCT05413330. Initial release 10/06/2022. Unique Protocol ID: UDMS-Opthal-01-2022.
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Affiliation(s)
- Sarah Zaher Addeen
- grid.8192.20000 0001 2353 3326Department of ophthalmology, Al Mouassat University Hospital, Damascus University, Damascus, Syria
| | - Iyad Shaddoud
- grid.8192.20000 0001 2353 3326Department of ophthalmology, Al Mouassat University Hospital, Damascus University, Damascus, Syria
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Go JA, Mamalis CA, Khandelwal SS. Cataract Surgery Considerations for Diabetic Patients. Curr Diab Rep 2021; 21:67. [PMID: 34967932 DOI: 10.1007/s11892-021-01418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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15
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Vadalà M, Trapani VS, Amato M, Bongiovanni G, Alaimo F, Cillino S, Bonfiglio VME. Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study. Eur J Ophthalmol 2021; 32:2760-2770. [PMID: 34878320 DOI: 10.1177/11206721211062037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of preoperative intravitreal dexamethasone implant (DexI) on functional and anatomic outcomes in patients with diabetic macular edema (DME) who underwent phacoemulsification cataract surgery. METHODS Prospective and non-comparative study conducted on consecutive DME patients undergoing cataract surgery. DexI was administered 15 days before surgery and in a pro re nata regime after surgery. Main outcome measures were mean change in central retinal thickness (CRT), central subfield thickness (CST), total macular volume (TMV), and central subfield volume (CSV) from baseline to month-12. Secondary outcome was mean change in best corrected visual acuity (BCVA). RESULTS Forty eyes were included in the study. CRT significantly decreased from 410.4 ± 64.8 µm at baseline to 303.2 ± 24.3 µm at month-12, p < 0.0001. Similarly, CST was significantly reduced from 436.4 ± 120.4 µm at baseline to 322.9 ± 54.2 µm at month-12, p < 0.0001. Total macular volume and CSV were significantly reduced from 9.95 ± 1.68 mm3 and 0.38 ± 0.11 mm3 at baseline to 8.49 ± 0.83 mm3 and 0.31 ± 0.05 mm3 at month-12, respectively (p < 0.0001 each, respectively). BCVA significantly improved from 0.26 ± 0.17 Snellen equivalent at baseline to 0.65 ± 0.19 at month-12, p < 0.0001. Mean DexI administered during the study were 2.0 ± 0.3. Neither DME subtype nor previous treatment status had any effect on functional or anatomic outcomes. Regarding safety, one (2.5%) eye developed ocular hypertension, which was successfully controlled with topical hypotensive treatment. CONCLUSIONS DexI was and effective and safe strategy for managing DME in diabetic patients undergoing uneventful cataract surgery.
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Affiliation(s)
- Maria Vadalà
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy.,IEMEST, Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | | | - Mario Amato
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Giuseppe Bongiovanni
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Francesco Alaimo
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
| | - Salvatore Cillino
- Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, Palermo, Italy
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Das AV, Prashanthi GS, Das T, Narayanan R, Rani PK. Clinical profile and magnitude of diabetic retinopathy: An electronic medical record-driven big data analytics from an eye care network in India. Indian J Ophthalmol 2021; 69:3110-3117. [PMID: 34708751 PMCID: PMC8725066 DOI: 10.4103/ijo.ijo_1490_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: This study aimed to describe the clinical profile and magnitude of diabetic retinopathy (DR) in patients presenting to a multitier eye hospital network in India. Methods: This cross-sectional hospital-based study included 263,419 individuals with diabetes mellitus (DM) presenting between February 2012 and February 2021 (9-year period). The data were collected using an electronic medical record (EMR). Patients with a clinical diagnosis of DR in at least one eye were included in the analysis. Severe nonproliferative DR/proliferative DR/diabetic macular edema (DME) were considered sight-threatening DR (STDR). Results: In the study period, 25% (n = 66,913) were new patients diagnosed with DR. The majority of patients were males (70%). The mean age of the patients was 57 ± 10 years. The risk factors for DR were increased age: 30 to 50 years (odds ratio [OR] = 2.42), and 51 to 70 years (OR = 3.02), increased duration of DM: 6 to 10 years (OR = 2.88) and >10 years (OR = 6.52), blindness (OR = 2.42), male gender (OR = 1.36), lower socioeconomic status (OR = 1.43), and rural habitation (OR = 1.09). STDR was seen in 58% (n = 38,538) of examined patients. Risk factors for STDR were increased age 31 to 50 years (OR = 3.51), increased duration of DM: 6 to 10 years (OR = 1.23) and >10 years (OR = 1.68), blindness (OR = 3.68), male gender (OR = 1.12), and higher socioeconomic status (OR = 1.09). Conclusion: Every fourth person with DM was found to have DR, and every second person with DR had STDR in this study cohort. These real-world big data might provide greater insight into the current status of DR. Additional big data from similar EMR-based sources will help in planning and resource allocation.
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Affiliation(s)
- Anthony Vipin Das
- Department of EyeSmart EMR and AEye; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gumpili Sai Prashanthi
- Department of EyeSmart EMR and AEye; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Center for Vitreo-Retinal Diseases; Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Center for Vitreo-Retinal Diseases, Hyderabad, Telangana, India
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17
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Abstract
Big data holds great promise to help unravel insights to bridge the gap in human understanding. There has to be an emphasis on the quality of the data points being collected to ensure meaningful analysis. India has made significant strides to lay down a strong framework through the National Digital Health Blueprint and the National Health Stack for the future. There is a need to focus on the first important step of collection of a “good quality” data point through the implementation of electronic medical records by the health care providers. In India, 60 million individuals move below the poverty line every year because of the expenses related to unforeseen illness that adversely affects the individual's welfare and the nation's economic growth. With an out-of-pocket expense rate currently at 70% and the government's health budget at a mere 1.3% of its GDP (gross domestic product), data-driven decisions are the need of the hour for policy making and to ensure equitable, efficient, and excellent delivery of health care. There is a huge potential to harness the power of big data to generate insights to address the four big challenges of health care in India – availability, accessibility, affordability, and acceptability.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR and AEye; Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India, Telangana
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18
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Thirunavukarasu AJ, Malem A, Mourtzoukos S. Combined Phacoemulsification and Intravitreal Dexamethasone Is an Effective Option for High-Risk Diabetic Macula Oedema Patients. Cureus 2021; 13:e17603. [PMID: 34646654 PMCID: PMC8482952 DOI: 10.7759/cureus.17603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Cataract surgery in diabetic patients carries an increased risk of post-operative macula oedema, particularly in those with a history of diabetic macula oedema (DMO) treatment or DMO at the time of surgery. We investigated whether simultaneous phacoemulsification with intravitreal Ozurdex® reduces the risk of developing new, or deteriorating current, DMO. Methods We conducted a retrospective review of 79 consecutive ‘high-risk’ diabetic patients who underwent phacoemulsification with intraocular lens insertion and intravitreal Ozurdex® implantation immediately subsequently. ‘High risk’ was defined as diabetic patients with prior treatment history for DMO or current DMO. Central macula thickness (CMT), best-corrected visual acuity and intraocular pressure were recorded pre-operatively, at two to four weeks and at three months post-operatively. A significant change in CMT was defined as a change of ≥0.1 LogOCT units. Results The mean age was 72.6 years; 52% were males. The mean pre-operative CMT was 365um. Thirty-seven per cent (37%) patients had prior DMO history that had resolved; 63% had confirmed DMO in surgery. Two to four weeks post-operatively, 82% of patients had stable CMT and 18% showed improvement. No patients deteriorated. Three months post-operatively, 48% of patients had stable CMT relative to pre-operative measurements, 38% improved, and 14% deteriorated. Analysis of variance (ANOVA) indicated no significant differences in response with demographical or pathological factors, including diabetic retinopathy grade and treatment history. Conclusion Phacoemulsification surgery combined with Ozurdex® insertion at the end of the procedure is a highly effective strategy for protecting against the formation of new, or the deterioration of current DMO, in the highest risk diabetic patients undergoing cataract surgery.
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Affiliation(s)
- Arun J Thirunavukarasu
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.,Department of Ophthalmology, School of Clinical Medicine, University of Cambridge, Cambridge, GBR.,Department of Ophthalmology, Corpus Christi College, University of Cambridge, Cambridge, GBR
| | - Andrew Malem
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR.,Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, GBR
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Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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Abdool Z, Naidoo K, Visser L. Implementation and evaluation of a team approach to managing diabetes mellitus and diabetic retinopathy in the South African district health system. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Diabetic retinopathy (DR) screening programmes have been developed and implemented in different countries based on availability of resources. Most protocols developed for DR have been solely dedicated to DR screening without involving systemic screening.Aim: To implement and evaluate a DR screening model utilising a team of healthcare practitioners (HCPs) to manage diabetes mellitus (DM) to reduce DR progression.Setting: Primary healthcare clinics and Voortrekker hospital in Waterberg district of Limpopo province.Methods: A cross-sectional study was conducted, in which a total of 107 patients with DM from seven clinics consented to participation. A proposed DR screening model was implemented where patients with DM were screened for systemic complications at clinics and referred to Voortrekker district hospital for retinal photography. Questionnaire responses evaluated the success of the screening process and operational challenges.Results: From the study population, 32 (29.1%) were male and 75 (70.1%) were female. The mean age of patients was 63.7 years with a mean weight of 80.69 kg. The mean duration of DM was 9.26 years and the mean haemoglobin A1c (HbA1c) level was 9.7%. From the 47 patients who had visual acuity less than 6/9, 74.5% had refractive error. About 10% (9.4%) had DR or diabetic macular oedema (DME) and 38.3% had other lesions. Referral to an ophthalmologist was necessary in 36.5% of cases.Conclusion: The implementation of a team approach to co-manage DM and DR utilising the developed protocol improved the quality of care for patients with DM in the district health system.
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Furino C, Boscia F, Niro A, D'Addario M, Grassi MO, Saglimbene V, Reibaldi M, Alessio G. DIABETIC MACULAR EDEMA AND CATARACT SURGERY: Phacoemulsification Combined With Dexamethasone Intravitreal Implant Compared With Standard Phacoemulsification. Retina 2021; 41:1102-1109. [PMID: 32897932 PMCID: PMC8078110 DOI: 10.1097/iae.0000000000002974] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare functional and anatomical results of combined phacoemulsification and dexamethasone intravitreal implant (Ozurdex; DEX-I) with standard phacoemulsification in diabetic patients with cataract. METHODS Retrospective, comparative, cohort study. Patients with nonproliferative diabetic retinopathy, macular edema, and cataract, treated routinely at the Eye Clinic, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy with phacoemulsification associated with DEX-I (n = 23; Phaco-Dex) or standard phacoemulsification (n = 23; Phaco-alone). Best-correct visual acuity, central subfield thickness, and intraocular pressure were assessed at baseline and monthly for 3 months after surgery, and t-test was used to assess change from baseline. A multilevel regression model with an unstructured correlation-type matrix to account for repeated data measures was used for statistical analysis in and between groups. RESULTS With Phaco-Dex, best-correct visual acuity increased significantly from the first month (P = 0.0005 vs. baseline) and remained stable at the following visits; central subfield thickness decreased significantly from Month 2 (P = 0.049 and P = 0.04 vs. baseline, respectively); at each timepoint, central subfield thickness was significantly lower in the Phaco-Dex group versus Phaco-alone. Intraocular pressure increased significantly during follow-up (P = 0.001 at Month 3 vs. baseline) but remained within the normal range. In the Phaco-alone group, best-correct visual acuity, and intraocular pressure did not show any significant changes after surgery, whereas central subfield thickness increased from Month 2 (P = 0.05 vs. baseline). CONCLUSION In diabetic patients with macular edema and visually significant cataract, combined treatment with phacoemulsification and DEX-I seemed to be effective, safe, and superior to standard phacoemulsification considering both functional and tomographic parameters.
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Affiliation(s)
- Claudio Furino
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Italy;
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy;
| | | | - Maria D'Addario
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Italy;
| | - Maria O. Grassi
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Italy;
| | - Valeria Saglimbene
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; and
| | | | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico Consorziale Bari, Italy;
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Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema : Dated August 2019. Ophthalmologe 2021; 118:40-67. [PMID: 33033871 DOI: 10.1007/s00347-020-01244-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Role of Oral Antioxidant Supplementation in the Current Management of Diabetic Retinopathy. Int J Mol Sci 2021; 22:ijms22084020. [PMID: 33924714 PMCID: PMC8069935 DOI: 10.3390/ijms22084020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/13/2022] Open
Abstract
Oxidative stress has been postulated as an underlying pathophysiologic mechanism of diabetic retinopathy (DR), the main cause of avoidable blindness in working-aged people. This review addressed the current daily clinical practice of DR and the role of antioxidants in this practice. A systematic review of the studies on antioxidant supplementation in DR patients was presented. Fifteen studies accomplished the inclusion criteria. The analysis of these studies concluded that antioxidant supplementation has a IIB level of recommendation in adult Type 1 and Type 2 diabetes mellitus subjects without retinopathy or mild-to-moderate nonproliferative DR without diabetic macular oedema as a complementary therapy together with standard medical care.
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Barone A, Russo V, Maggiore G, Loiodice MS, Stella A, Bux AV, Iaculli C. Dexamethasone intravitreal implant in patients with cataract and naïve diabetic macular edema. Eur J Ophthalmol 2021; 32:364-371. [PMID: 33757366 DOI: 10.1177/11206721211004395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess the feasibility and clinical effectiveness of dexamethasone intravitreal implant 0.7 mg (IDI) administered in diabetic patients to prevent the worsening of macular edema. METHODS Forty eyes of 40 consecutive patients with naïve macular edema secondary to diabetes mellitus who were treated with IDI administered preoperative (Group A: 20 patients) or IDI administered immediately after cataract surgery (Group B: 20 patients). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes were evaluated at baseline and at postoperative time points. RESULTS Follow-up study was 20 weeks. In Group A and B, mean BCVA improved significantly at all post-surgery time points (p < 0.05). In Group A and B, mean CMT decreased significantly at 16 weeks (p = 0.02 and p = 0.004, respectively). At week 20, CMT failed to reach statistical significance in both groups (p = 0.5, group A and p = 0.15, group B). No statistical differences were noted between groups in term of BCVA (with the exception of week 4 for the presence of cataract in Group A), CMT and IOP. CONCLUSIONS The use of intravitreal dexamethasone implant 1 month prior to scheduled cataract extraction or at the time of phacoemulsification appears to be safe and effective for at least 16 weeks after surgery.
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Affiliation(s)
- Antonio Barone
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Vincenzo Russo
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Giulia Maggiore
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | | | - Andrea Stella
- Department of Ophthalmology, University of Foggia, Foggia, Italy
| | - Anna Valeria Bux
- Department of Ophthalmology, University of Foggia, Foggia, Italy
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Clinical Observation of Phacoemulsification Combined with Intravitreal Injection of Conbercept in Cataract Patients with Diabetic Macular Edema. J Ophthalmol 2021; 2021:8849730. [PMID: 33628483 PMCID: PMC7884183 DOI: 10.1155/2021/8849730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Aim To observe the clinical efficacy and safety of phacoemulsification surgery combined with intravitreal injection of conbercept in cataract patients with DME. Methods This is a prospective clinical cohort study. Thirty-five cataract patients (49 eyes) with DME were divided into two groups. The observation group (23 eyes) underwent a cataract phacoemulsification surgery combined with intravitreal injection of conbercept 0.5 mg; the control group (26 eyes) underwent a cataract phacoemulsification surgery only. The visual acuity, central macular thickness (CMT), IOP, and anterior chamber flare were examined before surgery and 1 week and one month after surgery. Results The UCVA and BCVA in Log MAR in the observation group were lower than those in the control group at 1 week (p=0.032; p=0.041) and 1 month (p=0.035; p=0.039), respectively, after the surgery. The CMT of the observation group changed from 492.7 ± 32.2 μm before surgery to 341.6 ± 59.9 μm one week after surgery and 374.8 ± 48.3 μm one month after surgery. The CMT of control group increased after surgery. There was no significant difference in IOP and flare between the two groups at all following times. Conclusion In patients with DME, undergoing a cataract surgery combined with intravitreal injection of conbercept is safe and effective for visual improvement and CMT declination with relatively fewer IOP and flare fluctuation.
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Fallico M, Avitabile T, Castellino N, Longo A, Russo A, Bonfiglio V, Parisi F, Furino C, Panozzo G, Scorcia V, Carnevali A, Bandello F, Parodi MB, Cennamo G, Cillino S, Vadalà M, Sunseri Trapani V, Cagini C, Fiore T, Lupidi M, Parravano M, Varano M, Giorno P, Boscia F, Giancipoli E, Eandi C, Le Mer Y, Reibaldi M. Intravitreal dexamethasone implant one month before versus concomitant with cataract surgery in patients with diabetic macular oedema: the dexcat study. Acta Ophthalmol 2021; 99:e74-e80. [PMID: 32588978 DOI: 10.1111/aos.14516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To report clinical outcomes of two different timings of intravitreal dexamethasone (DEX) implant administration for prevention of diabetic macular oedema (DME) worsening following cataract surgery. METHODS This multicentre, retrospective study included patients with DME who received an intravitreal DEX implant 1 month before cataract surgery, 'precataract DEX' group, or at the time of cataract surgery, 'concomitant treatments' group. Inclusion criteria were a follow-up ≥3 months and ophthalmological examination with optical coherence tomography (OCT) imaging at baseline (cataract surgery) and throughout follow-up. Anatomical improvement was considered to be a decrease in OCT central subfield (CSF) thickness ≥20% compared to baseline. The primary outcomes were anatomical and functional results at 3 months. RESULTS Two hundred twenty-one patients were included: 136 in the 'precataract DEX' group and 85 in the 'concomitant treatments' group. At 3 months, a reduction of CSF thickness ≥ 20% was found in 7.3% of eyes in the 'precataract DEX group' and in 83.7% of eyes in the 'concomitant treatments' group (p < 0.001), with mean CSF thickness lower in the latter group (371 ± 52 µm versus 325 ± 57 µm, p < 0.001). At 3 months, mean best-corrected visual acuity had improved from baseline in both groups (p < 0.001), with no difference between groups (p = 0. 20). No serious systemic adverse events were reported. CONCLUSION Both approaches prevented a worsening of DME, showing a comparable visual outcome. Dexamethasone (DEX) implant given at the same time as cataract surgery provided a better anatomical outcome.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology University of Catania Catania Italy
- Eye Unit Southampton University Hospital Southampton UK
| | | | | | - Antonio Longo
- Department of Ophthalmology University of Catania Catania Italy
| | - Andrea Russo
- Department of Ophthalmology University of Catania Catania Italy
| | | | | | - Claudio Furino
- Department of Ophthalmology University of Bari Bari Italy
| | - Giacomo Panozzo
- Ophthalmology Unit Bussolengo Hospital Bussolengo Verona Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Adriano Carnevali
- Department of Ophthalmology University of “Magna Graecia” Catanzaro Italy
| | - Francesco Bandello
- Department of Ophthalmology University Vita‐Salute Hospital San Raffaele Milano Italy
| | | | - Gilda Cennamo
- Department of Public Health University of Naples Federico II Naples Italy
| | - Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Valentina Sunseri Trapani
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section University of Palermo Palermo Italy
| | - Carlo Cagini
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Tito Fiore
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | - Marco Lupidi
- Division of Ophthalmology Department of Surgery and Biomedical Science S Maria della Misericordia Hospital University of Perugia Perugia Italy
| | | | - Monica Varano
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | - Paola Giorno
- Department of Ophthalmology IRCCS ‐ Fondazione Bietti Rome Italy
| | | | | | - Chiara Eandi
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Yannick Le Mer
- Department of Ophthalmology Fondation Ophtalmologique A. De Rothschild Paris France
| | - Michele Reibaldi
- Department of Ophthalmology University of Catania Catania Italy
- Department of Surgical Science Eye Clinic University of Torino Torino Italy
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Ma LY, Rong A, Jiang Y, Deng SY. Effects of Femtosecond Laser-Assisted Cataract Surgery on Macular and Choroidal Thickness in Diabetic Patients. Ophthalmol Ther 2021; 10:137-150. [PMID: 33464557 PMCID: PMC7887143 DOI: 10.1007/s40123-020-00326-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction This study aimed to compare the short-term changes in retinal and choroid thickness in diabetic patients after femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification (PE) surgery. Methods A total of 47 eyes in the PE group and 44 eyes in the FLACS group were included. All patients underwent measurement of central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) before and after surgery using optical coherence tomography (OCT). Results The effective phaco time (EPT) in the FLACS group was significantly reduced. The BCVA differed significantly between the two groups at 1 week and 1 month after surgery. The CMT in both groups increased at 1 week after the operation. It did not return to the preoperative level until month 12 in the PE group. In the FLACS group, the CMT began to decrease at month 3 and recovered to the preoperative level at month 12. The SFCT of the two groups increased at week 1; it began to decrease at month 6 in the PE group but did not recover to the preoperative level until month 12. The SFCT in the FLACS group recovered to preoperative levels at month 6. In the PE group, baseline CMT values predicted CMT change at week 1 and months 1, 3 and 12 after surgery. In the FLACS group, baseline CMT predicted CMT changes at week 1, month 1 and month 3. In the FLACS group, EPT predicted SFCT change at month 3. Conclusion FLACS is safe and effective in patients with no fundus change or mild diabetic retinopathy. It has advantages in effectively reducing EPT, achieving good vision earlier and promoting faster recovery of the retinal and choroidal thickness. Preoperative CMT is a significant predictor of CMT changes in the early period after FLACS.
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Affiliation(s)
- Ling-Yun Ma
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China. .,Shanghai Xin Shi Jie Eye Hospital, Shanghai, 200050, China.
| | - Yi Jiang
- Shanghai Xin Shi Jie Eye Hospital, Shanghai, 200050, China
| | - Shu-Ya Deng
- Department of Ophthalmology, Tongji Hospital Affiliated to Tongji University, Shanghai, 200065, China
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Watanabe H, Takahara M, Katakami N, Matsuoka TA, Shimomura I. Preoperative fundus examination in patients with diabetes scheduled for surgery. J Diabetes Investig 2021; 12:1508-1511. [PMID: 33319481 PMCID: PMC8354501 DOI: 10.1111/jdi.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022] Open
Abstract
This study aimed to show the proportion of fundus examinations in patients with diabetes who were scheduled for surgery. We retrospectively analyzed 455 consecutive patients with diabetes admitted for surgery. Just 49% had fundus examinations before hospitalization. The decision tree analysis showed that the type of family doctor was the first split associated with fundus examination; patients treated by a diabetes specialist were more likely to receive the examination. In this subgroup, glycated hemoglobin levels ≥8.0% and age ≥71 years were associated with a lower proportion of receiving the examination. In patients whose family doctor was not a diabetes specialist, glycated hemoglobin levels <7.2% and body mass index <27.4 kg/m2 without severe comorbidities were associated with a higher proportion of receiving the examination. In conclusion, half of patients scheduled for surgery did not receive fundus examinations. A high‐risk population for not receiving the examination varied with the consultation setting.
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Affiliation(s)
- Hirotaka Watanabe
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Naoto Katakami
- Department of Atherosclerosis and Metabolism, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Taka-Aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan
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Abdool Z, Naidoo K, Visser L. Implementation and evaluation of a team approach to managing diabetes mellitus and diabetic retinopathy in the South African district health system. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Corbelli E, Fasce F, Iuliano L, Sacconi R, Lattanzio R, Bandello F, Querques G. Cataract surgery with combined versus deferred intravitreal dexamethasone implant for diabetic macular edema: long-term outcomes from a real-world setting. Acta Diabetol 2020; 57:1193-1201. [PMID: 32367246 DOI: 10.1007/s00592-020-01509-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/19/2020] [Indexed: 01/22/2023]
Abstract
AIMS To compare the long-term functional and anatomical outcomes of cataract surgery with combined versus 1-month deferred intravitreal dexamethasone implant (DEX) in eyes with pre-existing diabetic macular edema (DME). METHODS Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were retrospectively evaluated in both groups before treatments, then 1, 4, 12 and 24 months after DEX. RESULTS Forty eyes were analyzed, 20 in each group. BCVA disclosed comparable trends, increasing from similar starting values (p = 0.9913) to akin scores 1 month after DEX (p = 0.4229). After 4 months, it similarly reduced without significant variations within each group throughout the whole observation period. CRT was similar at the time of surgery (p = 0.6134) and was reduced by DEX injection in both samples, with a superior beneficial effect in the combined group after 1 month (p = 0.0010). At 4 months, CRT further elevated and remained overall stable in the long term without differences. By 12 months, 19 (95%) eyes received further injections: 1 (5%) fluocinolone, 3 (15%) received other DEX and fluocinolone, 13 (65%) ≥ 1 DEX only and 2 (10%) anti-VEGFs. During the second year, 6 additional eyes (from the 13 receiving DEX) switched to fluocinolone, reaching a total of 10 (50%). Similar results were observed in the deferred group. CONCLUSIONS DEX implant performed at the time of surgery achieved the same long-term functional and anatomical outcomes compared to a 1-month injection deferral in treating eyes with pre-existing DME that should undergo cataract extraction.
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Affiliation(s)
- Eleonora Corbelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Fasce
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Lorenzo Iuliano
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
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Alessio G, Boscia F, Caporossi A, Panozzo G, Reibaldi M, Staurenghi G, Varano M, Bandello F. Dexamethasone implants in patients with diabetic macular edema undergoing cataract surgery: Italian expert panel consensus statements. Eur J Ophthalmol 2020; 31:1122-1127. [PMID: 32635762 DOI: 10.1177/1120672120939500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Intravitreal corticosteroid implants based on sustained-release dexamethasone provide effective retinal delivery of drug for around 6 months for the treatment of diabetic macular edema (DME). As current recommendations on the management of patients with DME undergoing cataract surgery are limited, this article aims to highlight issues and provide guidance on the use of dexamethasone intravitreal implants (DEX-DDS) in patients with DME undergoing cataract surgery, based on the consensus findings of a panel of Italian experts. METHODS The panel developed a survey regarding the use of DEX-DDS in patients with DME undergoing cataract surgery, following a comprehensive literature search. The results of the survey were discussed at an experts' meeting in September 2018, with a structured approach to determining consensus. The routine management of patients with DME undergoing cataract surgery was also developed for use as a basis of discussion to highlight current issues. RESULTS Eight consensus statements are presented, along with key issues that highlight controversial/outstanding issues in the use of DEX-DDS in DME patients with cataracts. CONCLUSION The consensus statements can help provide practical guidance for clinicians in daily practice on the rationale, patient diagnosis and selection, and optimal management of patients with DME undergoing cataract surgery.
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Affiliation(s)
- Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari "A. Moro", Bari, Italy
| | - Francesco Boscia
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Aldo Caporossi
- Fondazione Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Lazio, Italy
| | | | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Sacco Hospital, University of Milan, Milan, Italy
| | | | - Francesco Bandello
- Department of Ophthalmology, IRCCS Ospedale San Raffaele, University Vita-Salute, Milan, Italy
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Rossi T, Panozzo G, Della Mura G, Giannarelli D, Ferrari D, Alessio G, Palmisano C, Telani S, Ripandelli G. Diabetes and diabetic retinopathy in patients undergoing cataract surgery: a prevalence study-DiCat study report #2. Acta Diabetol 2020; 57:645-650. [PMID: 31912329 DOI: 10.1007/s00592-019-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To report on the prevalence of diabetes, diabetic macula oedema (DME) and retinopathy and their respective grading in a large cohort of patients undergoing cataract surgery. METHODS Data on previous diagnosis of diabetes, fasting glucose, glycated haemoglobin, presence and type of retinopathy and other maculopathy of 3657 patients over 55 years of age undergoing cataract surgery in 13 centres scattered throughout Italy were analysed. RESULTS A total of 20.4% of patients were known diabetics and 27.9% of diabetics showed signs of retinopathy. Haemoglobin A1C was higher than 48 mmol/L (6.5%) in 32% of diabetics and 2.4% non-diabetics. Fasting blood glucose level was higher than 120 mg/dL in 4.3% non-diabetics and 50% diabetics. Duration of diabetes did not significantly correlate with either fasting glucose or glycated haemoglobin, while higher grades of diabetic retinopathy were significantly more prevalent as duration of disease increased. DME was present in almost 40% of diabetics and 22% of patients showed non-diabetic maculopathy. DISCUSSION Diabetic retinopathy and DME worsen after cataract extraction thus complicating long-term prognosis and requiring expensive injective therapy. Since unknown diabetics represent 2-4% of the many million cataract candidates and even known diabetics show poor metabolic control and high rates of DME, preoperative medical testing and accurate retinopathy screening may prove both ethically necessary and cost-effective.
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Affiliation(s)
- Tommaso Rossi
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy.
| | - Giacomo Panozzo
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Giulia Della Mura
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- Department of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Daniele Ferrari
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
| | | | | | - Serena Telani
- IRCCS Ospedale Policlinico San Martino IRCCS - UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy
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Goh JKS, Lim LL. Dealing with co-existent cataract and diabetic macular oedema: An increasingly common conundrum now solved? Clin Exp Ophthalmol 2020; 48:424-426. [PMID: 32367639 DOI: 10.1111/ceo.13764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jonathan K S Goh
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
| | - Lyndell L Lim
- Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, East Melbourne, Victoria, Australia
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Kabanarou SA, Xirou T, Boutouri E, Gkizis I, Vasilias D, Bontzos G, Chatziralli I. Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery. Sci Rep 2020; 10:5534. [PMID: 32218471 PMCID: PMC7099086 DOI: 10.1038/s41598-020-62561-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
To examine preoperative use of intravitreal dexamethasone implant in patients with refractory diabetic macular edema (DME) undergoing cataract surgery. Participants in this study were 17 patients with DME refractory to previous treatment with anti-vascular endothelial growth factor agents or dexamethasone implant, and co-existent cataract. All participants received intravitreal dexamethasone implant at baseline and underwent phacoemulsification within one month after its insertion. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) changes between baseline, time of cataract surgery and postoperative months 1, 2 and 3 were evaluated. At month 1 after surgery, BCVA improved significantly from 42.3 ± 9.6 to 58.7 ± 11.9 letters compared to baseline (p < 0.001) and the improvement was sustained at month 2 and month 3 postoperatively. One month postoperatively, CST improved significantly compared to baseline (p < 0.001) and the improvement was sustained at month 2 (p < 0.001), while at month 3 CST started to increase, but remained significantly lower than baseline (p = 0.003). At month 3 postoperatively, 35.3% of patients presented recurrence of ME. Patients with refractory DME and cataract can safely undergo phacoemulsification when dexamethasone implant is inserted one month prior to surgery to ensure adequate control of postoperative inflammation and prevent deterioration of ME.
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Affiliation(s)
| | - Tina Xirou
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Eirini Boutouri
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Ilias Gkizis
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Dimitrios Vasilias
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Georgios Bontzos
- Department of Ophthalmology, Korgialenio-Benakio Hospital, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, University of Athens, Athens, Greece
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Ikegami Y, Takahashi M, Amino K. Evaluation of choroidal thickness, macular thickness, and aqueous flare after cataract surgery in patients with and without diabetes: a prospective randomized study. BMC Ophthalmol 2020; 20:102. [PMID: 32169068 PMCID: PMC7071624 DOI: 10.1186/s12886-020-01371-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/04/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND In diabetic eyes, various choroidal abnormalities are noted in addition to changes in the retinal circulation, and the risk of increased aqueous flare and retinal thickening after cataract surgery is higher in diabetic eyes. Inflammation caused by surgery induces breakdown of the blood-retinal barrier and affects the retina, although the influence on the choroid is unknown. Several researchers have evaluated the choroidal thickness (CT) after cataract surgery in patients with diabetes; however, the results are inconsistent. The purpose of this study was to evaluate the influence of uneventful small-incision phacoemulsification cataract surgery on the subfoveal choroidal thickness (SCT), the central macular thickness (CMT), and aqueous flare in patients with diabetes. METHODS This study included 59 randomly selected eyes (33 eyes of patients with diabetes and 26 eyes of control patients without diabetes) undergoing small-incision cataract surgery. Among the diabetic eyes, 26 were without diabetic retinopathy, and the remaining eyes had non-proliferative diabetic retinopathy. Aqueous flare, CMT, and SCT measurements were performed before and at 1 week, 1 month, and 3 months after surgery. RESULTS The postoperative CMT continued to increase significantly until 3 months in both groups. Although the CMT was more in patients with diabetes than in patients without diabetes during the follow-up period, there was no significant difference between the two groups. The aqueous flare value increased until 3 months after surgery in both groups. Although the increase was significant at 3 months after surgery in patients with diabetes, the increase in controls was not significant. The aqueous flare values differed significantly between the two groups before and at 3 months after surgery. There was no significant within-group or between-group difference in pre- and postoperative SCT values. CONCLUSION In diabetic eyes with early stage of retinopathy, even small-incision cataract surgery can induce increased aqueous flare and macular thickening until 3 months, although there is no significant change in the choroidal thickness. Further studies are essential to evaluate choroidal changes after the cataract surgery in diabetic eyes.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Miyuki Takahashi
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Kana Amino
- Department of Ophthalmology, Musashino Red Cross Hospital, Tokyo, Japan
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Bhandari S, Biechl AC, Nguyen V, Squirrell D, Mehta H, Barthelmes D, Gillies MC. Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry. Clin Exp Ophthalmol 2020; 48:462-469. [PMID: 31885185 DOI: 10.1111/ceo.13707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
IMPORTANCE There are limited data on real-world outcomes of cataract surgery in eyes receiving intravitreal treatments for diabetic macular oedema (DMO). BACKGROUND Cataract surgery may exacerbate oedema in some eyes with DMO resulting in inferior outcomes. DESIGN Matched, case-controlled retrospective study of observational data in routine clinical practice. PARTICIPANTS Eyes receiving intravitreal treatments for DMO tracked in the Fight Retinal Blindness! Registry. METHODS Eyes that underwent cataract surgery were identified and matched 1:1 with phakic controls also receiving intravitreal injections for DMO. We also assessed potential factors that were associated with better visual acuity (VA) outcomes. MAIN OUTCOME MEASURES Change in VA 6 months after cataract surgery. RESULTS Cataract surgery was identified in 208 eyes of 156 patients of which 147 eyes had 6 months of observations before and after surgery. The mean VA 6 months after surgery improved by 10.6 letters and was similar to their matched phakic controls (68.8 vs 69.2 letters; P = 0.8). Mean CST both 6 months before (341 μm) and after (360 μm) surgery were similar (P = 0.08). However, these eyes had thicker maculae and they received more injections than their matched phakic controls both before and after surgery. Eyes with worse VA before surgery and those that had received intravitreal treatment in the 4 weeks preceding surgery were more likely to gain vision. CONCLUSIONS AND RELEVANCE Visual outcomes of cataract surgery in eyes receiving intravitreal therapy for DMO were reasonably better. Their maculae were thicker and required more injections in the 6 months before and after surgery than their phakic controls.
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Affiliation(s)
- Sanjeeb Bhandari
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
| | - Anne C Biechl
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vuong Nguyen
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
| | | | - Hemal Mehta
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia.,Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK
| | - Daniel Barthelmes
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia.,Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark C Gillies
- The University of Sydney, Sydney Medical School, Save Sight Institute, New South Wales, Australia
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Stellungnahme der DOG, der RG und des BVA zur Therapie des diabetischen Makulaödems. Ophthalmologe 2020; 117:218-247. [DOI: 10.1007/s00347-019-01015-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Panozzo G, Cicinelli MV, Augustin AJ, Battaglia Parodi M, Cunha-Vaz J, Guarnaccia G, Kodjikian L, Jampol LM, Jünemann A, Lanzetta P, Löwenstein A, Midena E, Navarro R, Querques G, Ricci F, Schmidt-Erfurth U, Silva RMD, Sivaprasad S, Varano M, Virgili G, Bandello F. An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification. Eur J Ophthalmol 2019; 30:8-18. [PMID: 31718271 DOI: 10.1177/1120672119880394] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIMS To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. METHODS The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. RESULTS Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. CONCLUSION A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.
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Affiliation(s)
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Albert J Augustin
- Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Josè Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), University of Coimbra, Coimbra, Portugal
| | | | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital de la Croix-Rousse, CHU de LYON, Hospices Civils de Lyon & Université de Lyon 1, Lyon, France
| | - Lee Merrill Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anselm Jünemann
- Department of Ophthalmology, Rostock University Medical Center, Rostock, Germany
| | - Paolo Lanzetta
- Istituto Europeo di Microchirurgia Oculare (IEMO), University of Udine, Udine, Italy
| | - Anat Löwenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
| | | | - Giuseppe Querques
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Ricci
- UOSD Patologie Retiniche, Policlinico Tor Vergata, University Tor Vergata, Rome, Italy
| | - Ursula Schmidt-Erfurth
- Vienna Clinical Trial Center (VTC), Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Rufino Martins da Silva
- Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Monica Varano
- IRCCS Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia, Rome, Italy
| | - Gianni Virgili
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesco Bandello
- Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Danni R, Viljanen A, Aaronson A, Tuuminen R. Preoperative anti-inflammatory treatment of diabetic patients does not improve recovery from cataract surgery when postoperatively treated with a combination of prednisolone acetate and nepafenac. Acta Ophthalmol 2019; 97:589-595. [PMID: 30620140 DOI: 10.1111/aos.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To examine preoperative anti-inflammatory treatment on recovery from cataract surgery in eyes of diabetic patients. METHODS A Prospective randomized clinical trial. One hundred and three eyes of 103 patients with diabetes undergoing routine cataract surgery were randomized (1:1) not to receive any preoperative anti-inflammatory medication or to receive preoperative topical anti-inflammatory medication with a combination of prednisolone acetate (10 mg/ml) and nepafenac (1 mg/ml). All eyes received postoperative anti-inflammatory combination therapy for 3 weeks. Recovery from surgery was recorded by a structured home questionnaire. Clinical outcome parameters were recorded at 28 days and 3 months. RESULTS Patient age and gender distribution, and all baseline ophthalmic and systemic parameters were comparable between the study groups. After surgery, conjunctival injection lasted 2.4 ± 1.7 days (mean ± SD) and irritation of the eye 3.3 ± 3.9 days in eyes without preoperative treatment, when compared to 1.6 ± 1.6 days (p = 0.067) and 2.4 ± 4.0 days (p = 0.431), respectively, in eyes with preoperative treatment. At 28 days, central subfield macular thickness (CSMT) increased 2.2 ± 20.2 μm in eyes without preoperative treatment, when compared 0.1 ± 25.2 μm (p = 0.670) in eyes with preoperative treatment. At 3 months, the respective CSMT change from baseline was -1.5 ± 26.9 μm and -3.4 ± 26.2 μm (p = 0.762). None of the eyes were reported with pseudophakic cystoid macular oedema (PCME) in either group. CONCLUSION Lack of preoperative anti-inflammatory treatment does not impair recovery from surgery or predispose diabetic patients to increased risk of PCME in eyes postoperatively treated with combination therapy of prednisolone acetate and nepafenac.
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Affiliation(s)
- Reeta Danni
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Antti Viljanen
- Medical Faculty University of Turku Turku Finland
- Medilaser and Coronaria Cor Group Oulu Finland
| | - Alexander Aaronson
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Department of Ophthalmology Helsinki University Hospital Helsinki Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group University of Helsinki Helsinki Finland
- Unit of Ophthalmology Kymenlaakso Central Hospital Kotka Finland
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Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA. United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. Br J Ophthalmol 2019; 103:837-843. [PMID: 30269098 PMCID: PMC6582816 DOI: 10.1136/bjophthalmol-2018-312568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. METHODS This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. RESULTS 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). CONCLUSIONS This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
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Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Aaron Y Lee
- University of Washington, Seattle, Washington, USA
| | | | | | - Clare Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peck-Lin Lip
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, UK
| | - Esther Cook
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK
| | | | | | | | - Randhir Chavan
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | | | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Centre at Bedford Hospital, Bedford, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | | | - Helen Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Bobby Paul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Dawn A Sim
- Moorfields Eye Centre at Croydon University Hospital, London, UK
| | | | | | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
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Mokbel T, Saleh S, Abdelkader M, El-Khouly SE, Abou Samra W, Mamdouh M. Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients. Int J Ophthalmol 2019; 12:387-392. [PMID: 30918805 DOI: 10.18240/ijo.2019.03.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/09/2018] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. METHODS The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. RESULTS The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 µm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.
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Affiliation(s)
- Tharwat Mokbel
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sameh Saleh
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mona Abdelkader
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sherief E El-Khouly
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Waleed Abou Samra
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed Mamdouh
- Mansoura Ophthlmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
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Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World J Diabetes 2019; 10:140-153. [PMID: 30891150 PMCID: PMC6422859 DOI: 10.4239/wjd.v10.i3.140] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.
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Affiliation(s)
- Hasan Kiziltoprak
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Yasin Sakir Goker
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
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Drinkwater JJ, Davis TME, Turner AW, Bruce DG, Davis WA. Incidence and Determinants of Intraocular Lens Implantation in Type 2 Diabetes: The Fremantle Diabetes Study Phase II. Diabetes Care 2019; 42:288-296. [PMID: 30523034 DOI: 10.2337/dc18-1556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/14/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the incidence of intraocular lens (IOL) implantation for cataracts between people with and without type 2 diabetes and to determine associated risk factors in those with type 2 diabetes. RESEARCH DESIGN AND METHODS Participants with type 2 diabetes (n = 1,499) from the community-based observational Fremantle Diabetes Study Phase II (FDS2) were age, sex, and zip code matched 1:4 with residents without diabetes. IOL implantation status was ascertained between entry (2008-2011) and the end of 2016 using validated data linkage. Age-specific incidence rates and incidence rate ratios (IRRs) for cataract surgery were calculated. Predictors of IOL implantation in FDS2 participants were assessed using proportional hazards and competing risk regression modeling. RESULTS The crude IRR (95% CI) for cataract surgery in FDS2 participants (mean ± SD age 62.8 ± 10.8 years at entry) versus the matched group without diabetes was 1.50 (1.32-1.71), with the highest relative risk in those aged 45-54 years at the time of surgery (7.12 [2.05-27.66]). Competing risk analysis showed that age at entry, diabetes duration, serum HDL cholesterol, serum triglycerides, a severe hypoglycemic episode in the past year, and Asian and southern European ethnicity increased the risk of cataract surgery in participants with type 2 diabetes (P ≤ 0.025). CONCLUSIONS People with type 2 diabetes, especially those in younger age-groups, are at a significantly increased risk of cataract surgery than matched people without diabetes. Multifaceted prevention strategies should be incorporated as part of routine care. As well as limiting ultraviolet light exposure, these might include lipid-modifying treatment and strategies to avoid severe hypoglycemia.
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Affiliation(s)
- Jocelyn J Drinkwater
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Timothy M E Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Angus W Turner
- Lions Eye Institute, Nedlands, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, Western Australia, Australia
| | - David G Bruce
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy A Davis
- Medical School, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
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Liu L, Herrinton LJ, Alexeeff S, Karter AJ, Amsden LB, Carolan J, Shorstein NH. Visual outcomes after cataract surgery in patients with type 2 diabetes. J Cataract Refract Surg 2019; 45:404-413. [PMID: 30638823 DOI: 10.1016/j.jcrs.2018.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the relation between diabetic retinopathy (DR) severity, duration of diabetes, insulin dependence, and preoperative hemoglobin A1c (HbA1c) with visual outcome after phacoemulsification for cataract in patients with type 2 diabetes. SETTING Kaiser Permanente Northern California, USA. DESIGN Retrospective case series. METHODS Information was obtained from the electronic medical record for patients, June 1, 2010, through May 31, 2015. Confounding factors and clustering of eyes within patients were controlled for using linear mixed-effects regression models for continuous outcomes and general estimating equations for dichotomous outcomes. RESULTS The study included 65 370 patients; 28% had type 2 diabetes without DR, 5% nonproliferative DR, and 1.2% proliferative DR. Patients with diabetes and no DR were as likely as those without diabetes to achieve a corrected distance visual acuity (CDVA) of 20/20 (odds ratio, 1.01; 95% confidence interval, 0.94-1.10). The odds of a postoperative CDVA of 20/25 or worse increased with the severity of retinopathy duration of diabetes and insulin dependence, but not with the preoperative HbA1c. Although the odds of a postoperative CDVA of 20/20 was lower in patients with DR, every DR group averaged 4 lines of CDVA improvement, the same as patients without diabetes. A longer duration of diabetes, insulin dependence, and elevated HbA1c were not associated with worse postoperative outcomes. CONCLUSION Patients with DR and cataracts were less likely to achieve a CDVA of 20/20 vision but gained as many lines of CDVA from phacoemulsification as patients without diabetes, showing no evidence that cataract surgery should be delayed in diabetic patients with elevated HbA1c.
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Affiliation(s)
- Liyan Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, USA.
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Laura B Amsden
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - James Carolan
- Department of Ophthalmology, Kaiser Permanente, San Rafael, California, USA
| | - Neal H Shorstein
- Departments of Ophthalmology and Quality, Kaiser Permanente, Walnut Creek, California, USA
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Habib AE, Abdel-Kader AA, Eissa IM, Awadein A. Adherence to Intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) Drugs in Diabetic Macular Edema in an Egyptian Population: A Health Belief Model. Curr Eye Res 2018; 44:303-310. [DOI: 10.1080/02713683.2018.1543708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ahmed E. Habib
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Iman M. Eissa
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Awadein
- Ophthalmology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Kelkar A, Kelkar J, Mehta H, Amoaku W. Cataract surgery in diabetes mellitus: A systematic review. Indian J Ophthalmol 2018; 66:1401-1410. [PMID: 30249823 PMCID: PMC6173035 DOI: 10.4103/ijo.ijo_1158_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Particularly, the early recognition and treatment of diabetic retinopathy or maculopathy before cataract surgery influence the final visual outcome and play a major role in perioperative decision-making. Better understanding of various factors responsible for favorable outcome of cataract surgery in diabetic patients may guide us in better overalll management of these patients and optimizing the results.
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Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal Mehta
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Winfried Amoaku
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nott Inghamshire, UK
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47
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Sarao V, Veritti D, Maurutto E, Rassu N, Borrelli E, Loewenstein A, Sadda S, Lanzetta P. Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opin Pharmacother 2018; 19:1551-1563. [PMID: 30185069 DOI: 10.1080/14656566.2018.1516206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cataracts and diabetes are widespread pathologies that are of growing concern to the global population. In diabetic patients who have had cataract surgery, the worsening of preexisting diabetic macular edema or occurrence of pseudophakic cystoid macular edema are common causes of visual impairment even with the most advanced surgical techniques available today for phacoemulsification. AREAS COVERED In this review, the authors assess the available literature to evaluate and compare different drugs, with the aim of establishing the best pharmacological strategies for the prevention and treatment of macular edema in diabetic patients undergoing cataract surgery. EXPERT OPINION Guidelines for the optimal management of diabetic macular edema in conjunction with cataract surgery or treatment of pseudophakic cystoid macular edema in diabetic patients are still lacking. To treat these conditions, clinicians need to understand the pharmacokinetics, posology, and efficacy of available drugs: topical non-steroidal anti-inflammatory drugs (NSAIDs), intravitreal anti-vascular endothelial growth factors (VEGFs), and both topical and intravitreal steroids. Diabetic patients undergoing cataract surgery should receive topical NSAIDs to prevent pseudophakic cystoid macular edema. Intravitreal anti-VEGFs and steroids, in association with cataract surgery, are indicated for patients with preexisting diabetic macular edema or those at high risk of macular edema after surgery.
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Affiliation(s)
- Valentina Sarao
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Daniele Veritti
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Erica Maurutto
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Nicolò Rassu
- b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
| | - Enrico Borrelli
- c Ophthalmology Clinic, Department of Medicine and Science of Ageing , University G. D'Annunzio Chieti-Pescara , Chieti , Italy
| | | | - Srinivas Sadda
- e Doheny Eye Institute , Los Angeles , CA , USA.,f Department of Ophthalmology, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Paolo Lanzetta
- a Department of Medicine - Ophthalmology , University of Udine , Udine , Italy.,b Istituto Europeo di Microchirurgia Oculare (IEMO) , Udine , Italy
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Alnagdy AA, Abouelkheir HY, El-Khouly SE, Tarshouby SM. Impact of topical nonsteroidal anti-inflammatory drugs in prevention of macular edema following cataract surgery in diabetic patients. Int J Ophthalmol 2018; 11:616-622. [PMID: 29675380 DOI: 10.18240/ijo.2018.04.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023] Open
Abstract
AIM To evaluate the efficacy of prophylactic administration of topical non-steroidal anti-inflammatory drugs (NSAIDs) on macular edema following cataract surgery in diabetic patients, and to compare between types of NSAIDs (ketorolac tromethamine 0.4% and nepafenac 0.1%). METHODS Group 1 (control) received artificial tears substitute as a placebo group, group 2 (nepafenac) received topical nepafenac 0.1%, and group 3 (ketorolac) received topical ketorolac tromethamine 0.4%. Patients were examined postoperatively after completing one week, one month, two months and three months' intervals for evaluating cystoid macular edema (CME) development. The main study outcomes were achieving the best corrected visual acuity (BCVA) and change in the central macular thickness (CMT) measured with optical coherence topography (OCT). RESULTS Eighty eyes of 76 patients were included in this study. BCVA showed a statistically significant difference at the third month postoperative follow up between the control group and the NSAIDs groups (P=0.04). There was an increase in the CMT in all cases starting from postoperative first week until third month. CMT showed a statistically significant difference between control group and NSAIDs groups from postoperative first month until third month (P=0.008, 0.027, 0.004). There was no statistically significant difference between nepafenac and ketorolac groups in BCVA and OCT CMT. CONCLUSION Prophylactic preoperative and postoperative NSAIDs may have a role in reducing the frequency and severity of CME in diabetic eyes following cataract surgery.
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Affiliation(s)
- Ahmed A Alnagdy
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Hossam Y Abouelkheir
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sherief E El-Khouly
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sahar M Tarshouby
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
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Modjtahedi BS, Fong DS. Re: Singh et al.: Nepafenac 0.3% after cataract surgery in patients with diabetic retinopathy: results of 2 randomized phase 3 studies (Ophthalmology. 2017;124:776-785). Ophthalmology 2017; 125:e10-e11. [PMID: 29268871 DOI: 10.1016/j.ophtha.2017.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/18/2017] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California.
| | - Donald S Fong
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California; Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
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