Original Investigation | Clinical Sciences, Journal Club

Macular Edema After Cataract Surgery in Eyes Without Preoperative Central-Involved Diabetic Macular Edema

Diabetic Retinopathy Clinical Research Network Authors/Writing Committee; Carl W. Baker, MD1; Talat Almukhtar, MBChB2; Neil M. Bressler, MD3; Adam R. Glassman, MS2; Sandeep Grover, MD4; Stephen J. Kim, MD5; Timothy J. Murtha, MD6; Michael E. Rauser, MD7; Cynthia Stockdale, MSPH2
[+] Author Affiliations
1Paducah Retinal Center, Paducah, Kentucky
2Jaeb Center for Health Research, Tampa, Florida
3Wilmer Ophthalmological Institute, Baltimore, Maryland
4Department of Ophthalmology, Jacksonville Health Science Center, University of Florida College of Medicine, Jacksonville
5Vanderbilt University Medical Center, Nashville, Tennessee
6Joslin Diabetes Center, Boston, Massachusetts
7Department of Ophthalmology, Loma Linda University Health Care, Loma Linda, California
JAMA Ophthalmol. 2013;131(7):870-879. doi:10.1001/jamaophthalmol.2013.2313.
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Importance  The incidence of development or worsening of macular edema (ME) is variable in eyes without diabetic ME (DME) undergoing cataract surgery.

Objective  To estimate the incidence of central-involved ME 16 weeks following cataract surgery in eyes with diabetic retinopathy without definite central-involved DME preoperatively.

Design, Setting, and Participants  In a multicenter, prospective, observational study, 293 participants with diabetic retinopathy without definite central subfield thickening on optical coherence tomography (OCT) underwent cataract surgery.

Exposure  Cataract extraction surgery performed within 28 days of enrollment of eyes without DME in individuals with diabetes mellitus.

Main Outcomes and Measures  Development of central-involved ME defined as the following: (1) OCT central subfield thickness of 250 μm or greater (time-domain OCT) or 310 μm or greater (spectral-domain OCT) with at least a 1-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; (2) at least a 2-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; or (3) nontopical treatment for ME received before the 16-week visit with either of the OCT criteria met at the time of treatment.

Results  The median participant age was 65 years. The median visual acuity letter score was 69 letters (Snellen equivalent 20/40). Forty-four percent of eyes had a history of treatment for DME. Sixteen weeks postoperatively, central-involved ME was noted in 0% (95% CI, 0%-20%) of 17 eyes with no preoperative DME. Of eyes with non–central-involved DME, 10% (95% CI, 5%-18%) of 97 eyes without central-involved DME and 12% (95% CI, 7%-19%) of 147 eyes with possible central-involved DME at baseline progressed to central-involved ME. History of DME treatment was significantly associated with central-involved ME development (P < .001).

Conclusions and Relevance  In eyes with diabetic retinopathy without concurrent central-involved DME, presence of non–central-involved DME immediately prior to cataract surgery or history of DME treatment may increase the risk of developing central-involved ME 16 weeks after cataract extraction.

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