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.

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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.

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Authors: Matthew R Starr, Michael A Mahr, Wendy M Smith, Raymond Iezzi, Andrew J Barkmeier, Sophie J Bakri