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Association of T1D and T2D With Higher Nd:YAG Capsulotomy Rates Following Cataract Surgery
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To assess the effect of diabetes type on Nd:YAG capsulotomy rates following cataract surgery.
DESIGN
A retrospective cohort study.
METHODS
All patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017 were included. The Nd:YAG capsulotomy rate following cataract surgery was assessed and compared between nondiabetic, type 1 diabetes (T1D), and type 2 diabetes (T2D) patients. Multivariate Cox regression analysis controlling for age and sex was used to estimate hazard ratios for Nd:YAG laser capsulotomies.
RESULTS
Included were 53,471 consecutive cataract surgeries. Overall, 42,651 eyes (79.8%) were in nondiabetic patients, 823 eyes (1.5%) were in T1D patients, and 9,997 eyes (18.7%) were in T2D patients. The mean follow-up time was 6.8 ± 4.2 years. In univariate analysis, the eyes of T1D patients (p < 0.001) and T2D patients (p = 0.003) had significantly higher Nd:YAG laser capsulotomy rates than the eyes of nondiabetic patients. In Cox regression analysis adjusted for the patient's age and sex, DM1 (HR 1.692, 95%CI 1.390-2.059, P<0.001) and DM2 (HR 1.157, 95%CI 1.075-1.244, P<0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates.
CONCLUSION
In our large cohort study, patients with T1D and T2D were predisposed to high risk for Nd:YAG capsulotomy following cataract surgery. This study may be beneficial and raise awareness regarding the assessment of posterior capsular opacification development in pseudophakic diabetic patients, particularly those with T1D. The significance of ophthalmology screening for diabetes individuals is further supported by this issue.
Additional Info
Disclosure statements are available on the authors' profiles:
T1D and T2D predispose to higher Nd:YAG capsulotomy rates following cataract surgery: analysis of 53,471 consecutive cases
Can J Ophthalmol 2024 Mar 18;[EPub Ahead of Print], M Cunha, O Elhaddad, T Yahalomi, V Avadhanam, D Tole, K Darcy, E Levinger, R Tuuminen, A AchironFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is a very interesting analysis of more than 53 thousand consecutive cataract surgeries performed in the UK, showing significantly higher rates of postoperative Nd:YAG laser capsulotomy in patients with diabetes mellitus than in those without diabetes over approximately 7 years. The question as to whether or not diabetes is an independent risk factor for posterior capsule opacification (PCO) has been debated, with some previous studies showing a reduced risk, others showing an equivalent risk, and others showing an increased risk of PCO in patients with diabetes.1 This particular study adjusted for age and sex, which is important since a younger age at the time of cataract removal is an established risk factor for PCO,2 and female sex appears to be a risk factor in some analyses.3
However, we see several potential confounders in this study, including the unavailability of data with respect to diabetes duration or glycemic control. At least one study found significantly higher levels of a specific advanced glycation end product (AGE) in the posterior capsules of patients with diabetes compared with controls.4 AGEs are causally linked to PCO formation in cultured human lens capsules by increasing epithelial-to-mesenchymal transition,5 and both diabetes duration and glycemic control are directly correlated with AGE formation. As such, it seems likely that glycemic exposure is better connected to PCO development than diabetes. Of note, metformin use is associated with a lower risk of PCO by reducing epithelial-to-mesenchymal transition underlying capsular fibrosis.6 Other potential factors clouding the data include ascertainment bias (patients with diabetes are followed more frequently for ocular complications, which may yield higher rates of intervention for relatively asymptomatic PCO formation) and intervention bias (patients with diabetic retinal disease may receive earlier treatment for PCO to facilitate better examination and/or imaging of the fundus).
The global prevalence of both cataract requiring surgical extraction and diabetes continues to increase.7,8 Treatment of posterior capsular opacification has been shown to improve visual acuity, stereopsis, and the ability to perform activities of daily living.9 This study suggests that there may be higher rates of PCO among patients with diabetes. Identifying and treating PCO in patients who have potentially visually debilitating comorbidities (such as diabetes) can result in an improved quality of life.
References