Outcomes of patients with active diabetic macular edema at the time of cataract surgery managed with intravitreal anti-VEGF injections: Outcomes of cataract surgery in active DME patients.
To investigate the outcomes of cataract surgery in patients with active diabetic macular edema (DME) who are receiving active treatment with intravitreal anti-vascular endothelial growth factor (VEGF) injections in the perioperative period.Retrospective clinical cohort study.All patients who underwent cataract surgery and were receiving intravitreal anti-VEGF injections from January 1st, 2012 through December 31st, 2017. Thirty-seven eyes underwent cataract surgery and received at least one intravitreal anti-VEGF injection for a diagnosis of DME within 6 months prior to surgery. Outcome measures included the development of subretinal or intraretinal fluid in the 6 months following surgery, timing of injections, number of injections, best corrected visual acuity (BCVA), and central subfield thickness (CST).There was a significant improvement between pre- and post-operative BCVA when comparing all eyes (p values <0.0001) and no significant difference in CST before and after surgery (p > 0.05). There were 30 eyes (81.1%) that had fluid on the pre-operative OCT. Seventeen eyes (45.9%) developed new or worsening post-operative DME. Comparing the eyes that did or did not develop worsening DME, there were no differences in post-operative visual acuities (p > 0.05). Eyes that did develop new fluid had significant increases in post-operative CST at both 1 month (350 versus 320 microns, p = 0.036) and 6 months (342 versus 305 microns, p = 0.013).In a real world setting, patients with cataracts and actively treated DME may undergo cataract surgery, but may see a worsening of DME not immediately affecting the BCVA.
Authors: Matthew R Starr, Michael A Mahr, Wendy M Smith, Raymond Iezzi, Andrew J Barkmeier, Sophie J Bakri