Visual outcome after phacoemulsification and IOL implantation in diabetic patients

Aims-To follow visual acuity (VA) and progression of diabetic retinopathy ( DR) after phacoemulsification in diabetic patients with different stages of DR and controls. Methods-This prospective study included 27 diabetic patients with no or mil d to moderate non-proliferative DR; 25 patients with moderate to severe non proliferative, or proliferative DR; and 22 non-diabetic controls. All patie nts underwent uncomplicated, phacoemulsification surgery, with implantation of a heparin-surface modified (HSM) poly(methylmethacrylate) (PMMA) intrao cular lens (IOL) into the capsular bag. Colour fundus photographs and fluor escein angiograms (FA) were taken at 1 week (baseline), 3 months, and 1 yea r postoperatively to determine stability or progression of DR. Results-The VA of 46 diabetic eyes (88%), was improved 1 year after surgery and only six eyes (12%) were unchanged or worse. 41 diabetic eyes (79%) ac hieved a VA of 0.5 or better and 11 eyes (21%) had a final VA lower than 0. 5. Significantly lower final corrected VA was found I year after surgery in eyes with advanced DR (median 0.5; range 0.1-1.0) compared with controls ( 1.0; 0.1-1.0) and eyes with no or mild to moderate DR (1.0; 0.1-1.0). Eyes with mild to moderate DR and clinically significant macular oedema (CSMO) 1 week postoperatively had a lower final VA than those without CSMO. Angiogr aphic cystoid macular oedema (CMO) was detected with FA in 15% of all diabe tic eyes 1 week postoperatively. 41 eyes (79%) showed no change or improvem ent of the retinal status 1 year after cataract surgery. Progression Mras f ound in 11 eyes (21%), mainly in eyes with mild to moderate DR and moderate to severe DR. Eyes with an indication for laser photocoagulation at baseli ne showed a significantly higher rate of progression of DR after surgery th an those without indication for laser treatment, Conclusion-The final visual outcome was improved in the majority of diabeti c eyes. Eyes with CSMO at the time of surgery had the worst prognosis regar ding postoperative VA.