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Incidence and Progression of Diabetic Retinopathy After Cataract Surgery
TAKE-HOME MESSAGE
- This systematic review and meta-analysis of 15 studies that reported the incidence or progression of diabetic retinopathy (DR) after cataract surgery concluded that DR progression was significantly higher after cataract surgery. The type of cataract surgery (phacoemulsification or extracapsular cataract extraction) and the analyzed risk factors, including age, duration of diabetes, HbA1c level, and insulin use, did not influence the risk of postoperative DR development or progression.
- These findings point to cataract surgery itself (and, presumably, the resulting inflammation) being the most important risk factor for DR progression.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
The impact of cataract surgery on diabetic retinopathy (DR) in patients with diabetes mellitus (DM) remains uncertain. This study aimed to investigate the incidence and progression of DR in patients with DM who underwent cataract surgery.
DESIGN
Meta-analysis.
METHODS
A systematic search of PubMed, Cochrane CENTRAL, and Embase databases was conducted from inception to April 2024. Randomized controlled trials or observational cohort studies involving adult patients with DM who underwent cataract surgery were included. Studies reporting data on the incidence or progression of postoperative DR were considered. Effect sizes were determined using risk ratios (RRs) with 95% confidence intervals (CIs), and meta-analysis was performed using a random-effects model. Subgroup analysis and meta-regression were conducted on perioperative demographic factors such as types of cataract surgery, DM durations, preoperative glycated hemoglobin A1c levels, and postoperative follow-up durations.
RESULTS
Data from 15 studies, involving 7,287 patients were analyzed. Postoperative DR incidence was elevated compared to the control group (RR, 1.38; 95% CI, 1.16-1.63; p < 0.001), although not significantly different in paired studies (RR, 0.85; 95% CI, 0.39-1.83; p = 0.671). DR progression was significantly higher after cataract surgery (RR, 1.46; 95% CI, 1.28-1.66; p < 0.001), irrespective of cataract surgery type and study design. Our analysis also revealed a significant increase in DR progression to sight-threatening DR, which includes clinically significant macular edema and proliferative diabetic retinopathy, following cataract surgery (RR, 1.84; 95% CI, 1.21-2.81; p = 0.005). Additionally, various risk factors such as preoperative HbA1c level, duration of postoperative follow-up, duration of diabetic diagnosis, age, and use of insulin therapy were investigated, However, none of these parameters significantly influenced the incidence or progression of postoperative DR.
CONCLUSIONS
Further research is needed to fully understand the incidence of DR after cataract surgery. However, our study provides moderate evidence supporting the progression of DR following such surgical interventions. Therefore, it is imperative to closely monitor DR progression within one year following cataract surgery in patients with DM.
Additional Info
Disclosure statements are available on the authors' profiles:
Incidence and Progression of Diabetic Retinopathy After Cataract Surgery: A Systematic Review and Meta-Analysis
Am J Ophthalmol 2024 Aug 21;[EPub Ahead of Print], SH Lee, BY Tseng, MC Wu, JH Wang, CJ ChiuFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Lee and co-authors conducted a systematic review and meta-analysis of published data regarding the incidence and progression of diabetic retinopathy (DR) after cataract surgery. The current analysis indicated a higher DR incidence after cataract surgery in non-paired studies; however, there was no such indication in paired studies. However, the possible reason for the difference between non-paired and paired studies was not further discussed in this study. The current report also confirmed a moderate association between a higher risk of DR progression and postoperative cataract surgery. This association existed irrespective of the type of cataract extraction, for instance, whether or not phacoemulsification was performed.
Based on the current review, clinicians may be alerted that cataract surgery is a risk factor for the incidence and progression of DR. However, owing to the literature review and de-identified nature of the current study, the establishment of clear and comprehensive criteria for post–cataract surgery DR progression is challenging. Therefore, more specific characteristics of DR progression may be used in analyses. For example, if optical coherence tomography inflammatory biomarkers were included, followed by a subgroup analysis, this study might provide more convincing evidence supporting the underlying mechanism linking DR and cataract surgery.