Markers of poor glycemic control are helpful to assess the risk of pseudophakic macular edema in diabetic cataract surgery patients

Abstract

We read with interest the article by Ylinen et al.1 The authors presented a prospective case series of 95 eyes in patients with diabetes having cataract surgery. The study aimed to specify the risk factors for pseudophakic cystoid macular edema in patients with diabetes. The eyes were examined preoperatively and 1 month postoperatively with full ophthalmic examinations and spectral-domain ocular coherence tomography. We recently presented a similar retrospective review of 88 diabetic eyes at the Kiawah Eye Meeting in June 2017.A In our study, we reviewed the charts of 88 eyes, following the patient from preoperative evaluation up to 1 year after cataract surgery. Similar to Ylinen et al., we sought to identify risk factors for developing macular edema after cataract surgery in our diabetic patients. We examined preexisting data in the electronic medical record. The mean age of our patient cohort was 66 years. Fifty-six patients were African American, the remainder were white. The mean hemoglobin A1c (HbA1c) within 90 days of cataract surgery was 8.1. Twenty-nine patients were insulin dependent, 30 had nonproliferative diabetic retinopathy (DR), and 11 had proliferative DR. Of these 88 patients, 10 developed macular edema. The mean HbA1c was 7.9 in the group that did not develop macular edema and 8.9 in the group that did develop macular edema (P = .216). In addition, 9 patients who developed macular edema had preexisting nonproliferative DR, which conveyed a relative risk of 22.9 (P < .05). All 10 patients who developed macular edema were insulin dependent with a relative risk of 9.86 (P < .05). Our study is ongoing and we hope to strengthen this data with a larger cohort. In summary, our experience agrees with Ylinen et al.,1 that indicators of poor glycemic control such as HbA1c, severity of DR, and insulin dependency status are all risk factors for developing pseudophakic macular edema in diabetic patients after cataract surgery. While our population appears to have more severe diabetic disease, we suspect that this represents differing patient demographics. Our experience supports the conclusions of Ylinen et al.1 It is important clinically to identify these patients preoperatively and ensure that they are counseled appropriately about their increased risk for pseudophakic macular edema during the informed consent process. However, we realize that a larger prospective study is needed to further elucidate and risk-stratify these patients.