Panretinal photocoagulation during cataract extraction in eyes with activeproliferative diabetic eye disease

Purpose Cataract surgery in the presence of active proliferative diabetic e ye disease carries a high risk of progression of retinopathy and neovascula r glaucoma. Lens opacities may prevent panretinal photocoagulation (PRP) be fore surgery, and applying PRP in the immediate post-operative period can b e difficult. The purpose of this study is to report results of cataract ext raction combined with per-operative indirect laser PRP in a group of these patients. Methods Nine eyes of 9 diabetic patients with active retinal or iris neovas cularisation in which lens opacities prevented adequate preoperative PRP un derwent cataract surgery combined with indirect laser PRP after cortex aspi ration and before intraocular lens implantation. Results Regression of neovascularisation with this combined procedure alone was achieved in 5 eyes, 3 responded to further PRP, and 1 developed neovas cular glaucoma. Visual acuity improved in all eyes, 4 achieving greater tha n or equal to 6/12. Four patients developed increased postoperative uveitis . One developed clinically significant macular oedema. Conclusions The method described has definite practical advantages over PRP attempted in the immediate post-operative period, when many factors can pr event its application or reduce its effectiveness, and when neovascularisat ion may be progressing rapidly. In addition, adjunctive per-operative indir ect laser PRP appears to improve the outcome of cataract surgery in eyes wi th active proliferative diabetic eye disease.