What do you tell your patients?...
The risk of progression of non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) following cataract surgery is always on our minds in terms of outcomes for our patients. While modern phacoemulsification has reduced surgical trauma, individuals still face an increased risk of post-op retinopathy progression. Several factors naturally contribute to this including the duration and severity of diabetes, pre-existing retinopathy stage, and glycemic control.
We now have more information regarding the statistical likelihood of progression. A comprehensive analysis of real-world data from the TriNetX US Collaborative research network found individuals with NPDR who underwent cataract surgery did have a higher incidence of PDR development compared to matched controls. The hazard ratio for progression was found to be statistically significant.
This of course is a reminder to implement preventive measures such as optimizing glycemic control before surgery and possibly considering pre-operative anti-VEGF therapy in high-risk cases. Post-surgery management is key, with recommendations for more frequent retinal examinations as well as macular OCT's.
Understanding this, we must carefully weigh the visual benefit against the potential risk when planning cataract surgery - emphasizing the need for individualized patient management and closer collaboration with endocrinology.
-JRM
Go to the article in Ophthalmology: HERE
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