Diabetic Retinopathy and Cataract Extraction

As both diabetes and cataract become more prevalent with advancing age, many patients may require treatment for both conditions. Research has shown that cataract surgery may worsen both diabetic retinopathy and diabetic macular edema (DME). Accordingly, special care should be taken when considering cataract surgery in patients with diabetes. Prior to cataract surgery, patients without a known history of diabetes should be screened for diabetes, as well as for hypertension and abnormalities in renal function. Patients who have diabetes should undergo a complete ophthalmologic assessment, including fluorscein angiography and optical coherence tomography (OCT). If the assessment shows no signs of retinopathy, cataract surgery can be done safely. If mild to moderate nonproliferative diabetic retinopathy (NPDR) is present, cataract surgery can still be considered, but should be undertaken with caution. For patients with severe NPDR, treatment with panretinal photocoagulation should be done to control the retinopathy before cataract surgery is performed. Patients with clinically significant macular edema (CSME) should be treated with focal laser photocoagulation prior to surgery and may be treated perioperatively with steroids. For patients with severe PDR, a vitrectomy may be necessary to control the retinopathy sufficiently enough to perform cataract surgery. Patients who have diabetic retinopathy and cataract surgery should be informed that their diabetic retinopathy may progress as a result of the surgery and that clinically significant macular edema may also result. Following surgery, patients should be monitored closely, and a low threshold for treatment should be used.