Preop assessment, proper lens placement necessary in diabetic cataract patients

PUNTA DEL ESTE, Uruguay — Before performing cataract surgery on a diabetic patient, surgeons must assess the extent of macular edema and any present retinopathy, according to a surgeon speaking here. Intraoperatively, intracapsular placement is also key, he said.

At the Curso Regional Panamericano, Alberto Zambrano, MD, discussed complications of cataract surgery and IOL implantation in diabetic patients.

If a surgeon sees a diabetic patient for the first time when he presents for cataract surgery and the patient has a high level of macular edema, "we have to see if the macular edema is significant due to the diabetes or if this is Irvine-Gass syndrome," Dr. Zambrano said.

Irvine-Gass syndrome is present in 30% of diabetic patients with diabetic retinopathy but just 2% of healthy patients, he said.

"If there is significant macular edema, and it is pre-existing and has been diagnosed, 28% of these patients are expected to worsen after cataract surgery," Dr. Zambrano said.

If it is not diagnosed preoperatively, he said the surgeon will face the postoperative question of whether the increased macular edema is undiagnosed Irvine-Gass or normal postoperative edema. If it is not Irvine-Gass, the edema will improve in 56% of patients over the first year after surgery, he said.

"A key thing when we place an IOL in a patient with diabetic retinopathy and a certain degree of pressure is not to position the lens poorly and not to place a lens in a patient with severe retinopathy," he said.

"It is important to place the lens in the bag. Most of the cases that had to be resolved were because the lens was in contact with the ciliary," Dr. Zambrano said.