There has been recent interest in the progression of diabetic;retinopa
thy following extracapsular cataract extraction (ECCE) especially with
vitreous loss, Tt is well known that diabetic retinopathy progresses
after intracapsular cataract extraction (ICCE) but was thought to be l
ess common after ECCE. We present 7 patients with symmetrical non-prol
iferative diabetic retinopathy who underwent ECCE with intraocular len
s (IOL) implantation, These patients ranged in age from 56 to 69 years
; 2 were insulin-dependent diabetics (IDDM) and 5 non-IDDMs, Rubeosis
iridis developed quickly between post-operative outpatient visits desp
ite good diabetic control and a static retinal picture in the fellow e
ye, Visual loss following the onset of rubeosis was severe, with 3 pat
ients needing cyclocryotherapy and eventually having no perception of
light. The rapid onset of rubeosis between post-operative outpatient v
isits leads us to suggest much shorter periods between reviews than is
current practice and the consideration of routine panretinal photocoa
gulation in the immediate post-operative period in diabetics with wors
ening retinopathy after ECCE and IOL, Possible causes of the increase
in neovascularisation and rubeosis are discussed, The most important m
essage highlighted by these case histories is that the surgery and fol
low-up of diabetic patients undergoing surgery should be undertaken by
an ophthalmologist with an interest in diabetes, Where there is no re
cognised diabetic retinal specialist in a unit, then early referral to
such an ophthalmologist is recommended when complications arise.