PROGRESSION OF DIABETIC-RETINOPATHY AND RUBEOTIC GLAUCOMA FOLLOWING CATARACT-SURGERY

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.