Phacoemulsification In Diabetic Patients Research Articles

Evaluation of the corneal thickness and endothelial changes following uncomplicated phacoemulsification in diabetic and non-diabetic patients with pseudo-exfoliation syndrome by specular microscopy.

To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX. This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT. By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction. Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications. The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).

The effect of topical ketorolac tromethamine on macular thickening after phacoemulsification in diabetic patients

BackgroundTo determine the effect of ketorolac tromethamine 0.5% in preventing post-phacoemulsification macular thickening. This randomized clinical trial. patients randomized 1:1 to receive either topical ketorolac three times a day or a placebo.MethodsA total of 101 eyes of 101 diabetic patients who were scheduled for phacoemulsification and had normal macular contour and thickness enrolled consecutively. The topical ketorolac and placebo were prescribed on the day before surgery and continued up to 4 weeks after surgery. Patients with proliferative diabetic retinopathy, a history of intravitreal injection in less than three months, a history of macular photocoagulation in less than 6 months, and any other concomitant ocular pathologies were excluded. Central macular thickness (CMT) and best corrected visual acuity (BCVA) was recorded in the follow-ups of 6, 12, and 24 weeks after the surgery and compared with the controls.Results49 eyes in the case group and 52 eyes in the control group were analyzed. Mean BCVA was significantly improved in both groups at all follow-ups (P < 0.001 for all). There was no statistically significant difference regarding the BCVA in different time points except week 12 (P = 0.028) among the study group. In the case and control groups, CMT was increased at all follow-ups (P < 0.05). There was no statistically significant difference when comparing the two groups regarding the mean of CMT at any time point postoperatively (P > 0.05 for all).ConclusionBased on our findings, topical ketorolac tromethamine 0.5% is not effective in the prevention of post-phacoemulsification macular thickening in diabetic patients.Trail registrationThe study protocol was registered into www.clinicaltrial.gov with the RCT registration number NCT03551808. (2018/06/11 )Clinical trial registration numberNCT03551808.

Correlation between postoperative central corneal thickness and endothelial changes after cataract surgery by phacoemulsification in diabetic patients

Correlation between postoperative central corneal thickness and endothelial changes after cataract surgery by phacoemulsification in diabetic patients

Combined phacoemulsification surgery and intravitreal triamcinolone injection versus stand-alone surgery in patients with type 2 diabetes: a prospective randomized trial

BackgroundWe would assess the efficacy of intravitreal injection of triamcinolone acetonide IVTA combined with standard phacoemulsification on the central subfield macular thickness (CSMT), the progression of diabetic retinopathy (DR), and the corrected distant visual acuity (CDVA) in type 2 diabetic patients.MethodsIn this prospective single-blinded randomized clinical trial we recruited patients with type 2 diabetes who were eligible for cataract surgery. The patients were randomly assigned to two groups. The case group received an intravitreal IVTA at the end of phacoemulsification, and the control group had routine surgery. CSMT, progression of DR, CDVA, IOP, and adverse events including endophthalmitis were compared between the groups preoperatively and at 1, 3, and 6 months postoperatively.ResultsAmong a total of 66 patients that were treated within the study period, 50 patients were included in the final analysis. The case group comprised 21 eyes, and the control group included 29 eyes. Regression models and corrected ANOVA test for repeated measures showed a significant reduction in CSMT at 3 and 6 months postoperatively, which was most significant when the preoperative CSMT was ≥300 μm, with a cut-off value of 347.3 μm in the case group (p < 0.000). DR progression was halted in the case group at 6 months with 52.38% of patients having their DR classified as moderate (P = 0.012). CDVA was significantly improved from baseline 6/60 (logMAR 1.0) pre-op to 6/6 (logMAR 0.00) at 6 months post-op in the case group, and from baseline 6/120 (logMAR 1.3) pre-op to 6/12 (logMAR 0.3) at 6 months post-op in the control group. The gain in visual acuity was significantly higher in the case group at all study points (p < 0.001). No significant rise in IOP was observed at any study point in both groups (p = 0.23 > 0.05). No endophthalmitis was recorded.ConclusionsDiabetic patients benefit significantly from cataract surgery. This study supports IVTA injection at the end of phacoemulsification in diabetic patients. Triamcinolone is an affordable (which is of particular importance in low-income countries as per our setting), and relatively safe “phaco-enhancer”.Trial registrationNCT05413330. Initial release 10/06/2022. Unique Protocol ID: UDMS-Opthal-01-2022.

Occurrence of cystoid macular edema after uneventful phacoemulsification in diabetic patients without retinopathy: A hospital-based comparative study

This study aims to determine the incidence of CME after uneventful phacoemulsification in diabetic patients without any signs of retinopathy and nondiabetic patients in early post-operative periods. The present study was a prospective, comparative, hospital-based study conducted from December 2019 to December 2020 in the Ophthalmology department of a tertiary care referral hospital in Eastern India. All patients aged between 50 to 80 years of either sex with cataract grade nuclear sclerosis II–III with or without cortical cataract and early posterior subcapsular cataract undergoing uncomplicated phacoemulsification surgery by a single surgeon were included in the study. The patients were divided into 2 groups. Group 1 consisted of Type 2 diabetes mellitus patients with cataracts with no retinopathy changes on funduscopy and group 2 included healthy non-diabetic patients with cataracts. Comprehensive baseline evaluation including central retinal thickness (CRT) measurement using optical coherence tomography was done in all cases. Best corrected visual acuity (BCVA) and CRT were assessed 1 week and 6 weeks following surgery. Seventy-four patients were included in the study. Both the groups consisted of 37 cases each. The mean age in group 1 and group 2 was 62.24 ± 6.36 and 63.30 ± 6.39 years respectively. One patient in each group developed clinical CME in the postoperative period. The incidence of CME in our study was 2.7%. Improvement in BCVA was comparable in both groups and statistically insignificant. An increase in CRT was found to be statistically significant (P= 0.047) in group 1 at the 6th week follow-up. Visual outcomes in diabetic patients without retinopathy are similar to normal patients following uncomplicated phacoemulsification surgery.

Prophylaxis of macular edema after cataract surgery in diabetic patients, topical Nepafenac versus intravitreal Ranibizumab.

To compare effect of topical Nepafenac versus intravitreal Ranibizumab on macular thickness after cataract surgery in diabetic patients with no preoperative macular edema. A prospective randomized controlled study recruited diabetic patients with visually significant cataract and no diabetic macular edema (DME). Patient underwent uncomplicated phacoemulsification with IOL implantation and were randomly assigned to receive post-operative topical Nepafenac, intra-operative intravitreal Ranibizumab, or no prophylactic treatment. Changes in subfoveal and perifoveal macular thickness were assessed by SD-OCT. The mean central macular thickness showed a significant increase in all study groups 1 week and 1 month postoperative when compared to baseline. At 3 months postoperative, there was a significant difference between Nepafenac and Control group (p = 0.017), Ranibizumab and Control groups (p = 0.009) with no significant difference between Nepafenac and Ranibizumab group (p = 0.545) regarding CMT. Comparable results could be detected as regarding peri-foveal macular thickness changes. Concerning BCVA, there was a significant difference between topical Nepafenac/control (p = 0.001) and intravitreal Ranibizumab/control (p = 0.004) at 1-week visit. No significant difference in BCVA was observed between Nepafenac and Ranibizumab group throughout the whole study period. In postoperative visits, cystoid macular edema occurred in three patients (7.9%) in Nepafenac group, one patient (2.7%) in Ranibizumab group, and seven patients (17.07%) in control group. Both postoperative topical Nepafenac and intra-operative intra-vitreal Ranibizumab are effective adjunctive to phacoemulsification in diabetic patients for prophylaxis of macular edema.

Progression Of Diabetic Retinopathy After Uncomplicated Phacoemulsification In Diabetic Patients

BackgroundDiabetes is the most common risk factor for cataract. Cataract remains one of the major causes of blindness in diabetic patients. Some studies report an increased risk of progression, whereas others report that this progression simply represents the natural course of the disease rather than a surgical outcomeObjectivesTo evaluate the influence of uncomplicated unilateral phacoemulsification on postoperative progression of diabetic retinopathy in diabetic patientsMethodsBetween February 2018 and August 2018, this prospective observational study included 20 diabetic patients, who were fit for unilateral phacoemulsification, of both genders aged from 35 to 80 years, with Grade I – Grade II cataract and with mild to moderate non-proliferative diabetic retinopathy. The process included 6 months of follow up with complete clinical ophthalmic examination, Fluorescein fundus angiography and Optical coherence tomographyResultsOur study included 20 patients; study report 6 males and 14 females with mean age of 58±11 years; 17 had mild NPDR and 3 had moderate NPDR. Comparing preoperative and final postoperative visit for the whole study group, 30% showed regression of the DR (6 out of 20), 35% had no significant change (7 out of 20) and 35% showed progression (7 out of 20)ConclusionUncomplicated phacoemulsification cataract surgery may not be responsible for an accelerated rate of DR progression postoperatively. Instead, any DR progression that does occur postoperatively followed a benign course and may simply represent the natural history of the disease

Assessment of subfoveal choroidal thickness after uneventful phacoemulsification in diabetic patients

Background Phacoemulsification is an intraocular surgery that may worsen preexisting retinal diseases by inducing inflammation in the posterior segment of the eye. It is related to interleukin-1β expression and genes’ upregulation in both retina and choroid. Choroid imaging with enhanced depth imaging (EDI) facilitated choroidal thickness measurement. Aim The aim was to assess the changes in subfoveal choroidal thickness following uncomplicated phacoemulsification in diabetic patients − without retinopathy − using EDI of spectral-domain optical coherence tomography. Patients and methods This prospective observational study included 60 eyes of 60 patients who underwent cataract extraction by phacoemulsification, subdivided into two groups, the first group was 30 eyes of patients had diabetes with no retinopathy, the second one was 30 eyes of nondiabetic healthy patients as a control. Using EDI-spectral-domain optical coherence tomography, subfoveal choroidal thickness (SFCT) was evaluated 1 week preoperatively and 1 month postoperatively. Results The mean age of both groups was 59.033±9.072 and 58.200±8.235, respectively. In group I, mean preoperative SFCT was 194.600±27.523 µm and 1 month postoperatively was 207.100±27.530 µm. In group II, mean preoperative SFCT was 191.233±17.520 µm and 1 month postoperatively was 193.133±17.085 µm. Regarding operative time and phaco power, in group I, mean time was 12.583±2.051 min and mean power was 28.900±12.645%, whereas in group II, mean time was 11.667±1.845 min and mean power was 22.333±7.849%. Conclusion Phacoemulsification induces nonsignificant nonpathological increase in SFCT with the presence of diabetes as a systemic disease but without local diabetic changes in the eye; however, a significant difference was observed between patients with and without diabetes as regards SFCT.

Retinal changes after uncomplicated phacoemulsification in diabetic patients

Aim To detect the incidence and progression of diabetic retinopathy (DR) and macular edema following uncomplicated phacoemulsification in cataractous diabetic patient. Patients and methods A prospective randomized interventional study was performed at Al-Zahraa Hospital, during the period from April 2017 to December 2018. Informed written consent was taken from each participant in the study. A total of 60 eyes of 30 cataractous diabetic patients with type II diabetes were classified into two groups: group A included 30 cataractous eyes that underwent uncomplicated phacoemulsification surgeries with posterior chamber foldable intraocular lens implantation, and group B included contralateral nonoperated 30 eyes of the same patients. Results There was a statistically significant increase of mean postoperative central macular thickness (CMT) at 1, 3, and 6 months in comparison with mean preoperative CMT in group A (P&lt;0.05). It was 223.43±15.95 preoperatively. At all duration of follow-up, the mean CMT in group A was more than that in group B, with a statistically significant difference (P&gt;0.05). Conclusion Phacoemulsification surgery most probably does not cause acceleration of DR in patients having no DR or mild DR and no maculopathy preoperatively.

Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study.

PurposeTo compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients.MethodsFifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography.ResultsA significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients.ConclusionPhacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.

Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients.

To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography (OCT) foveal thickness and multifocal electroretinogram (MF-ERG) parameters. The study included two groups. Group 1 included 50 diabetic patients with senile cataract (50 eyes, 30 females, 20 males, aged 55±7y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract (50 eyes, 22 female, 28 males, aged 53.8±8y) did not receive nepafenac. All patients were followed up for 3mo postoperatively. OCT and MF-ERG were done preoperative and at 1wk, 1, 2 and 3mo. The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema (CMO) (10%), and no patients in Group 1 developed central macular thickening more than 50 µm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic Patients

Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgeryby phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group 1: Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed with diabetes based on medical history and all were on medical treatment. In this prospective randomized study, preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values are statistically significant in both groups. On the other hand, in term of CV, the difference between preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical traumaand has a lower capability in the process of repair.

Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic Patients

Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgeryby phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group 1: Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed with diabetes based on medical history and all were on medical treatment. In this prospective randomized study, preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values are statistically significant in both groups. On the other hand, in term of CV, the difference between preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical traumaand has a lower capability in the process of repair.

Observation on the efficacy of periocular triamcinolone acetonide injection in preventing delayed uveitis after cataract surgery in diabetic patients

Objective To observe the efficacy of periocular triamcinolone acetonide(TA) injection for preventing delayed uveitis after phacoemulsification in diabetic patients. Methods The data of 592 eyes of 592 diabetic patients with cataract who received phacoemulsification combined with intraocular lens implantation from Jan. 2016 to Jun. 2018 were analyzes retrospectively. All patients were divided into three groups randomly. Group A, 197 eyes received phacoemulsification without medicine injection. Group B, 206 eyes received subconjunctival injection of dexamethasone (2.5 mg) after phacoemulsification, while 189 eyes in group C received periocular injection of TA (20 mg) after phacoemulsification. The follow-up time was for 1-3 months after surgery. Results Twelve eyes (6.1%) in group A suffered from delayed uveitis after surgery, 4 eyes (1.9%) in group B and 1 eye (0.5%) in group C. The difference of the incidence of delayed uveitis was not statistically significant between group A and B (χ2=4.55, P=0.03>0.0167), and the difference was statistically significant between group A and C(χ2=9.17, P=0.00 0.0167). Conclusion Periocular injection of TA and subconjunctival injection of dexamethasone are effective in controlling delayed uveitis in diabetic patients following phacoemulsification. Key words: Diabetes mellitus; Cataract; Phacoemulsification; Uveitis, delayed; Triamcinolone acetonide; Periocular injection

Macular Changes after Uneventful Phacoemulsification in Diabetic Patients in a Tertiary Hospital

Macular Changes after Uneventful Phacoemulsification in Diabetic Patients in a Tertiary Hospital

Corneal Endotheleal Cells Changes after Phacoemulsification in Type II Diabetes Mellitus

Background: Corneal endothelial cells are responsible for the clarity of the cornea; however, endothelial cells have limited cell division ability. Studies have proven that cornea is more vulnerable to chronic changes affecting endothelial cells in diabetic patients. Cataract extraction by phacoemulsification is one of the most ophthalmic surgeries having a negative effect on the corneal endothelial cells especially in elders. Age of the patient and diabetes mellitus have a negative effect on the outcome of phacoemulsification. The aim of the study is to compare the changes occur in corneal endothelium pre and post cataract extraction by phacoemulsification in diabetic patients in aspects of BCVA, CCT, CD, CV and HEX. Aim of the work: To assess endothelial cells changes following cataract extraction by phacoemulsification and posterior chamber IOL implantation in type II diabetic patients. Methods: The study included 20 eyes of 20 patients scheduled for cataract surgery by phacoemulsification at Al Azhar university hospitals. The patients were assigned to 2 groups. Group 1: Ten patients without diabetes were used as a control group, and a casual blood glucose test and glucose tolerance test were undertaken in accordance with the recommendations of the American Diabetes Association to disclose undetected diabetes. Group 2: Ten patients diagnosed with type II diabetes based on medical history and all were on oral anti-diabetic medication or subcutaneous treatment with insulin. Serum glycosylated hemoglobin (HbA1c) was obtained in all patients with diabetes to evaluate their glycemic status.In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy ( Topcon SP- 1P,Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, in group 1 the CCT mean ±SD in preoperative is 510.7 ±35.13, in 1 month postoperative is 522.1 ±35.91 and in 6 months postoperative is 512 ±34.91, the difference between preoperative CCT and 6 months postoperative is 1.3 ±0.95. In group 2 the CCT mean ±SD in preoperative is 497.45 ±25.82, in 1 month postoperative 515.64 ±26.59 and in 6 months postoperative is 500.18 ±25.5, the difference between preoperative CCT and 6 months postoperative is 2.73 ±1.64. In term of CD, in group 1 the CD mean ±SD in preoperative is 2678 ±390, in 1 month postoperative is 2599 ±378 and in 6 months postoperative is 2571 ±355, the difference between preoperative CD and 6 months postoperative is -107.17 ±15.53. In group 2 the CD mean ±SD in preoperative is 2872 ±335, in 1 month postoperative is 2703 ±326 and in 6 months postoperative is 2441 ±284, the difference between preoperative CD and 6 months postoperative is -430.8 ±50.31. In term of CV, in group 1 the CV mean ±SD in preoperative CV is 34.4 ±2.95, in 1 month postoperative is 35.2 ±3.05 and in 6 months postoperative is 35 ±2.6, the difference between preoperative CV and 6 months postoperative is 0.7 ± 1.34 which is statistically insignificant. In group 2 the CV mean ±SD in preoperative CV is 36 ±3, in 1 month postoperative is 37 ±3.16 and in months postoperative is 36 ±3.2, the difference between preoperative CV and 6 months postoperative is -0.3 ±1.64 which is statistically insignificant. In term of HEX, in group 1 the HEX mean ±SD in preoperative is 34 ±8, in 1 month postoperative 29 ±7 and in 6 months postoperative 28 ±7, the difference between preoperative and 6 months postoperative is -6.2 ±1.55 which is statistically significant. In group 2 the mean HEX mean ±SD in preoperative is 33 ±10, in 1 month postoperative is 25 ±7 and in 6 months postoperative is 24 ±7, the difference between preoperative HEX and 6 months postoperative is -8.7 ±2.58 which is statistically significant. In term of BCVA, in group 1 the BCVA mean ±SD in preoperative is 0.15 ±0.05, in 1 month postoperative is 0.38 ±0.11 and in 6 months postoperative is 0.5 ±0.07, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. In group 2 the BCVA mean ±SD in preoperative is 0.128 ±0.034, in 1 month postoperative is 0.285 ±0.0369 and in 6 months postoperative is 0.392 ±0.093, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the process of repair.

The effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients

Objective To investigate the effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients. Methods Forty two eyes of 42 cataract patients with diabetes and hypercholesterolemia who underwent phacoemulsification surgery were divided into interventional group (23 patients) and non-interventional group (19 patients) by random number table methods. The blood glucose and pressure of patients in two groups was controlled strictly before and after surgery. 10 mg Atorvastatin calcium per day was delivered one day after cataract surgery for the patients of interventional group and used for 24 weeks. No lipid-lowing agent was provided to the patients of non-interventional group. The main outcome measures included the best corrected visual acuity (BCVA), central retina thickness (CRT), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). No significant difference was shown in the BCVA, CRT, TC, LDL-C and HDL-C in two groups before phacoemulsification surgery (t=1.251, 1.257, 1.031, 1.042, 1.461; P>0.05). At the end of the 24 weeks after surgery, the efficacy evaluation and comparative analysis were performed. The analysis included the BCVA, the incidence of macular edema, CRT, TC, LDL-C and HDL-C. Results The BCVA was no significantly different between two groups one day after surgery (t=1.523, P>0.05). But 4, 12, 24 weeks after phacoemulsification surgery, the BCVA in interventional group was better than that in non-interventional group(t=3.920, 3.012, 7.025; P 0.05). Whereas, the significance difference of the CRT was occurred in two groups 4, 12, 24 weeks after surgery(t=4.673, 7.583, 9.035; P 0.05). Conclusion The treatment of Atorvastatin calcium effectively reduced the incidence rate of macular edema in hypercholesterolemia patients with good glycemic and hypertension control after phacoemulsification surgery. Key words: Macular edema/drug therapy; Hydroxymethylglutaryl-CoA reductase inhibitors/therapeutic use

The effect of topical sodium diclofenac on macular thickness in diabetic eyes after phacoemulsification: a randomized controlled trial.

To evaluate the efficacy of prophylactic administration of the topical diclofenac 0.1% on macular thickness in diabetic patients following phacoemulsification and intraocular lens implantation surgery. In a Randomized double-masked clinical trial, 108 eyes of 108 diabetic patients underwent phacoemulsification and intraocular lens implantation surgery were enrolled. Fifty four eyes received the conventional postoperative care with steroid drop, whereas the other group (54 eyes) was given a preoperative diclofenac drop four times daily in addition to steroid drop and continued 6weeks after surgery. All patients were evaluated by optical coherence tomography (OCT) preoperatively and days 1, 30, and 90. The outcome measures including best-corrected visual acuity and OCT findings were compared in and between both groups. Mean CMT changed from 239±16 and 235±17 at baseline to 249±15 and 254±28 at 3months in the case and control groups, respectively(p=0.003). Mean total volume of macula changed from 7.61±0.22 and 7.56±0.3 at baseline to 7.64±0.22 and 7.65±0.31 at 3months in the case and control groups, respectively (p=0.820). In comparison to the quadrants thicknesses and mean of them between groups did not reach the significant level. This study showed that there is a beneficial effect of topical diclofenac for prevention of macular thickness increasing following phacoemulsification in diabetic patients.

Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis.

ObjectiveTo evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT) and best corrected visual acuity (BCVA) in both diabetic patients without diabetic retinopathy (DR) and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR).MethodsPotential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD) and 95% confidence interval (CI) for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model.ResultsA total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95%CI, -1.230 to -0.399), 3 months (SMD, -0.565; 95%CI, -0.927 to -0.202) and 6 months (SMD, -0.458; 95%CI, -0.739 to -0.177) in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95%CI, -2.433 to 0.021)and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95%CI, -1.252 to 0.182) and 6 months (SMD, -1.181; 95%CI, -2.625 to 0.263) in diabetic patients without DR.BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95%CI, 0.251 to 2.047; and SMD,1.349; 95%CI, 0.264 to 2.434, respectively) and 6 months (SMD, 1.295; 95%CI, 0.494 to 2.096; and SMD, 2.146; 95%CI, 0.172 to 4.120, respectively) in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable.ConclusionUncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR. BCVA was significantly improved in both diabetic patients without DR and diabetic patients with mild to moderate NPDR.

Effect of intravitreal triamcinolone acetonide injection on central macular thickness in diabetic patients having phacoemulsification

To assess the effect of intraoperative intravitreal injection of triamcinolone acetonide on the central macular thickness, visual outcomes, and development of cystoid macular edema (CME) after phacoemulsification in diabetic patients. Farabi Eye Hospital, Tehran, Iran. In this prospective randomized controlled study, patients with diabetes were randomly assigned to a treatment group, which received an intravitreal injection of triamcinolone acetonide at the end of phacoemulsification, and a control group, which had routine phacoemulsification. Visual acuity, center-point thickness, central 1.0 mm subfield mean thickness, CME development, and diabetic retinopathy progression were compared between the 2 groups 1, 3, and 6 months postoperatively. The treatment group comprised 20 eyes and the control group, 21 eyes. There was no statistically significant difference between the 2 groups in the mean corrected distance visual acuity at any follow-up examination (P>.05). The mean change in center-point thickness and central 1.0 mm subfield mean thickness was statistically significantly lower in the treatment group than in the control group at all follow-up visits (P<.05). Four eyes in the control group and no eye in the treatment group developed CME (P = .059). Three eyes (15%) in the treatment group developed an intraocular pressure rise that was managed by topical medication. Intravitreal injection of triamcinolone reduced the amount of increase in center-point thickness and central 1.0 mm subfield mean thickness after phacoemulsification in eyes of diabetic patients. Although it also reduced the incidence of CME, it had no effect on visual acuity gain.