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Strategy needed to prevent inflammation, PCO after cataract surgery in diabetic patients
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 Rupert Menapace |
ISTANBUL, Turkey — When performing cataract surgery in diabetic patients, minimization of inflammatory reactions and prevention of posterior capsule opacification are more crucial than ever.
"What is always true for cataract surgery is even truer when it comes to performing it in an eye where the risk of exacerbation or development of macular edema is extremely high and where fundus visualization is vital," Rupert Menapace, MD, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.
Safe surgery in this regard starts with the smallest possible incision, preferably at the limbus. Capsulorrhexis should be circumferential, with minimal rhexis/optic overlap, which is essential for PCO prevention. Meticulous cortical clean-up is mandatory. Large-optic, looped-design hydrophobic acrylic IOLs with a sharp posterior edge are preferable.
Posterior capsulorrhexis provides a second line of defense against PCO, particularly if Dr. Menapace's technique of posterior optic buttonholing is used.
Finally, intensified and prolonged anti-inflammatory treatment with NSAIDs and corticosteroids should be administered, and anti-VEGF injection should be considered in case of manifest diabetic macular edema.
"If cataract surgery can be delayed, consider anti-VEGF injection as a preoperative treatment and wait to perform surgery until the edema is dried out. If cataract removal cannot be delayed, as in cases of dense cataract, do your surgery and perform anti-VEGF injection at the end of the procedure," Dr. Menapace said.