Phaco increases diabetic retinopathy progression rate in diabetic patients

Ophthalmology. 2009;116(8):1510-1514.

Diabetic patients had a higher rate of diabetic retinopathy progression 12 months after phacoemulsification, a study found.

The clinic-based study looked at a cataract surgical cohort of 1,994 patients in Australia. Digital retinal photography was used to compare diabetic retinopathy progression in operated pseudophakic eyes and non-operated phakic eyes. The study focused on 190 patients with type 1 or type 2 diabetes who underwent phaco, 169 of whom were followed for 12 months or more after surgery. Of those 169 patients at 12 months, 278 eyes were pseudophakic and 60 eyes were phakic.

The study authors found that by 12 months postop, incident diabetic retinopathy occurred in 28.2% of pseudophakic eyes and 13.8% of phakic eyes.

"In a paired-eye comparison of 45 patients who remained unilaterally pseudophakic at 12 months and were at risk of [diabetic retinopathy] progression, 35.6% of pseudophakic eyes exhibited [diabetic retinopathy] progression compared with 20% of the fellow phakic eyes," they said.

In addition, 56 patients who had unilateral surgery before the study had a statistically significant higher prevalence of diabetic retinopathy than phakic eyes in the study.

The authors noted that even though there was a doubling of the diabetic retinopathy progression rate with phacoemulsification, it was less "disruptive" than intracapsular or extracapsular cataract extraction.

"Although these findings should not argue against performing cataract surgery in older people with diabetes, it is important for clinicians to recognize this residual risk and to take appropriate precautions," they said.