Surgery In Diabetic Patients Research Articles

Visual outcome of cataract surgery by phacoemulsification in diabetic versus non-diabetic patients: A comparative study

This study aims to evaluate and compare the results of phacoemulsification cataract surgery performed on diabetic patients with those of non-diabetic patients. The primary objective was to compare the visual outcome of phacoemulsification cataract surgery in diabetic patients and non-diabetic patients, and the secondary objective was todetermine the final visual outcome following phacoemulsification cataract surgery in diabetics and non-diabetics.A comparative study of the overall 300 eyes of the patients, in which 150 eyes were diabetic and 150 eyes were non-diabetic, underwent phacoemulsification cataract surgery with posterior chamber intra ocular lens implantation. Age, sex, follow-up, preoperative and postoperative best corrected visual acuity and post-operative complications were evaluated. Out of the 300 eyes of the patients, 150 eyes were diabetic and 150 eyes were non-diabetics. Phacoemulsification with posterior chamber intra ocular lens implantation was done in all patients. Follow up duration was 6 weeks. Postoperatively, 6 weeks after surgery, 31.7% of patients had BCVA of 6/9 or better in diabetic group while 36.3% of patients had BCVA of 6/9 or better in non-diabetic group. The difference in BCVA between two groups at postoperative 6 weeks was found to be statistically significant p value of <0.001. Post-operative complications included wound leak, striate keratopathy, folds in descemets membrane, corneal haze or edema, iritis, posterior capsular rent, cystoid macular edema, iridodialysis. The incidence was higher in the diabetic group as compared to non-diabetics. Overall, the final visual outcome was better in non-diabetic group as compared to diabetic group. Diabetics are more likely to develop intra operative and postoperative complications. Thus, special care should be used both throughout the surgical procedure and the post-operative period.

Cataract and Diabetes: a review of the literature.

Cataracts can cause visual impairment in diabetic patients. Diabetes mellitus (DM) affects different parts of the eye and causes many complications and problems before, during and after intraocular surgeries. In this review, we will discuss the effects of diabetes on different aspects of cataract surgery and review the current management of diabetic cataracts. Careful preoperative examination of the patient's ocular surface, cornea, iris and posterior segment, as well as the use of advanced phacoemulsification techniques, new intraocular lenses (IOLs) and the appropriate use of auxiliary medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and anti-vascular endothelial growth factors (VEGFs) have improved the outcomes of cataract surgery in diabetic patients.

Incidence of Posterior Capsule Rupture During Phacoemulsification Cataract Surgery Among Patients Treated With Intravitreal Bevacizumab Injections.

To assess whether intravitreal bevacizumab injections increase the risk of posterior capsular rupture during phacoemulsification cataract surgery in diabetic patients. A retrospective study that included diabetic patients who underwent phacoemulsification cataract surgery at King Hussein Medical Center of the Jordanian Royal Medical Services during a one-year period from January 2023 until January 2024. Patients were categorized into four groups. The first group did not receive an intravitreal bevacizumab injection; the second group received only one injection; the third group received two injections; and the fourth group received three or more injections. Results from the four groups were compared with a control group for patients who underwent phacoemulsification surgery and were not known to have diabetes mellitus and did not receive previous intravitreal injections. All injections were received within a period of one year before the time of phacoemulsification surgery. Inclusion criteria for the study groups included diabetic patients with a history of diabetes of more than 10 years with the presence of diabetic retinopathy. Exclusion criteria included patients who received intravitreal injections other than bevacizumab, previous intraocular surgery or trauma, and the presence of ocular pathology that led to an increased risk of posterior capsular rupture. The incidence of posterior capsular rupture was compared among these groups. A p-value was used to assess statistical significance and was considered to be statistically significant if ≤0.05. The number of patients in the control group (group 0) was 1440 patients with a mean age of 64.9, and in the study groups were 1306 patients. Group 1 included 244 patients (18.7%) with a mean age of 62.4 years, compared to 306 patients (23.4%) in group 2 with a mean age of 66.1 years, 352 patients (27%) in group 3 with a mean age of 64.2 years, and 404 patients (30.9%) in group 4 with a mean age of 63.1 years. Posterior capsular rupture occurred more significantly in patients with group 4. It occurred in 21 patients, representing 5.2% of them, compared to four patients (1.6%) of group 1, six patients (2%) of group 2, and eight patients (2.3%) of group 3, while in the control group, the number of patients with posterior capsular rupture was 20 (1.4%). Intravitreal bevacizumab in diabetic patients is considered a risk factor for posterior capsular rupture in phacoemulsification cataract surgery in patients receiving more than three injections.

Intraocular lens selection in diabetic patients: How to increase the odds for success.

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Worsening of early DME after cataract surgery. The DICAT II Study report #2.

To analyse the long anatomical and functional outcome of a subgroup of the DICAT II study cohort, consisting of 26 patients undergoing cataract surgery and withdrawn from the study for a clinically significant worsening of early diabetic macular edema (DME). Patients who underwent cataract surgery and withdrawn from the DICAT II study for a clinically significant worsening of early DME with at least 12 months follow-up after the dropout. The study population was divided into two groups according to the clinical evaluation at one-year follow-up: ongoing treatment patients for DME (Treatment group, TG) and patients no longer treated (Non Treatment group, NTG). Central foveal thickness (CFT) at baseline and dropout time were higher in TG than in the NTG, with a statistically significant difference (p < 0.05). In addition, TG patients reported a higher levels of glycated hemoglobin at time baseline compared to NTG patients (7.81 ± 1.15 vs 7.02 ± 0.56; p = 0.048). The linear regression analysis demonstrated a statistically significant relationship between the visual acuity and the ongoing treatment group at one-year follow-up (p = 0.042). The study provides parameters to be considered when assessing the risk of developing persistent DME after cataract surgery in diabetic patients. In particular, CFT at baseline and dropout time have been reported to be an effective and predictable OCT biomarkers when evaluating DME progression. During the evaluation of the systemic disease, similar results were found for the glycated hemoglobin at baseline.

Comparative assessment of the corneal endothelium following phacoemulsification surgery in patients with type II diabetes and nondiabetes

Abstract: PURPOSE: The purpose is to assess the corneal endothelial changes after phacoemulsification surgery in diabetic patients and compare with those of nondiabetic subjects. METHODS: The study compared the corneal endothelial changes in diabetics and nondiabetics after phacoemulsification surgery. The study population included 40 patients with diabetes mellitus with good glycemic control and 40 nondiabetic patients who underwent uneventful phacoemulsification surgery. Central corneal endothelial cell density (ECD), central corneal thickness (CCT), and percentage of hexagonality percentage coefficient of variation (%CV) were measured preoperatively and postoperatively (at 4 and 12 weeks) using a specular microscope. RESULTS: Mean ECD loss (%) was measured as 9.85% and 8.41% at 4 weeks and 12 weeks postoperatively in the diabetic group while ECD loss percentage was 7.09% and 5.74% in the control group at the same time intervals, respectively. Furthermore, a significant difference was noted on comparing mean ECD measurements between the two groups at the postsurgical visits (4 weeks and 12 weeks). While the CCT was found to be similar in both diabetic and nondiabetic patients, increase was observed in the values of (%CV in both the groups at postoperative 4 weeks’ and 12 weeks’ follow-up. The values of both %CV and percentage hexagonality showed statistically significant differences between the diabetic and nondiabetic group before surgery and at 4 weeks’ and 12 weeks’ postoperative examinations. CONCLUSION: The patients with diabetes suffered greater endothelial damage despite good glycemic control as compared to nondiabetic patients which indicates the necessity of far more care to protect cornea endothelium in patients with diabetes.

Determinants of gastric residual volume before elective surgery in diabetic patients: An observational study.

We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.

Awareness About the Benefits of Post-bariatric Surgery in Diabetic Patients in Makkah Almukarramah, Saudi Arabia.

To measure awareness about the benefits of post-bariatric surgery, which is a shortening of the gut in order to lose weight in diabetic patients in the Makkah region, Saudi Arabia. A cross-sectional survey was conducted among diabetic patients aged 18-65 from February to July 2023. An online questionnaire via Google Forms was distributed and used to assess the participants' awareness of the benefits of post-bariatric surgery for diabetic patients. Overall, 388 participants (56.40% female, 43.60% male) were surveyed. Most participants (91.5%) showed awareness of gastric sleeve surgery, while a significant proportion (85.8%) recognized obesity as a disease. A majority of participants (80.90%) showed awareness of the association between obesity, diabetes, and high blood pressure. However, only 46.10% of participants showed awareness of eligibility criteria associated with bariatric surgery. The majority recognized the effectiveness of bariatric surgery for weight loss but did not consider it the first choice, emphasizing a preference for non-surgical weight loss strategies. Participants demonstrated good knowledge about obesity and its implications for health. They also demonstrated good knowledge about bariatric surgery as an effective weight reduction method but expressed a preference for non-surgical methods, which reflects their awareness of the complications of bariatric surgery. However, the results showed a lack of awareness of postoperative indications and lifestyle changes, thus highlighting the need for comprehensive patient education and counseling.

Assessment of macular thickness following cataract surgery in diabetic patients

Background: Cataracts and diabetes very commonly coexist. While the results of cataract extraction (CE) procedure are astounding, patients with diabetes may have more unfortunate visual outcomes in comparison to their counterparts. Aims and Objectives: This study is planned to see the frequency of development of macular oedema (ME) in diabetic patients as compared to non-diabetics and also to see the progression of ME after cataract surgery. Materials and Methods: This prospective comparative study enrolled 100 diabetics and 100 non-diabetics undergoing cataract surgery fulfilling inclusion criteria. Complete ocular examination was done for both the groups preoperatively and postoperatively at 1 week, 1 month, and 3 months including central macular thickness evaluation using optical coherence tomography (OCT). Results: Improvement in visual acuity was observed in both the group but, non-diabetics achieved better visual acuity in comparison to diabetics. A significant increase in mean central foveal thickness (CFT) in diabetics and in non-diabetics post 1 month of surgery was observed; however, at 3 month, the difference was not significant. All the patients with mild, moderate, and severe non-proliferative diabetic retinopathy (NPDR) showed increment in the CFT from the baseline value but none of the patient of mild NPDR grade presented with new development of clinically significant macular edema on OCT. Conclusion: Cataract surgery causes a significant increase in macular thickness post 1 month of surgery in both diabetic and non-diabetics. Cataract surgery did not lead to the progression of stages of DR, although patients with all the three grades of DR showed increment in CFT from the baseline reference value.

Comparison of the Effectiveness of Intravitreal Bevacizumab Injections with and without Simultaneous Cataract Surgery in Diabetic Patients with Macular Edema.

Intravitreal bevacizumab (IVB), often injected during cataract surgery, is currently the main treatment for diabetic macular edema. This retrospective study aimed to compare the effectiveness of IVB injections alone and during cataract surgery in patients with diabetic macular edema. We examined 43 eyes in 40 patients who underwent cataract surgery with simultaneous IVB injections 3-12 months after IVB injections alone. Best-corrected visual acuity and central subfield macular thickness (CMT) were measured 1-month post-injection. The CMTs of the same eyes with IVB-only first and combined-treatment procedures later were 384 ± 149 vs. 315 ± 109 μm pretreatment (p = 0.0002), and after 1 month, they were 319 ± 102 vs. 419 ± 183 μm (p < 0.0001). In the IVB-only procedure, 56.1% of eyes had CMT < 300 μm 1 month after the injection compared to 32.5% after the combined treatment. Therefore, on average, when IVB was administered during cataract surgery, CMT increased, whereas after IVB injection alone, it effectively decreased. More prospective trials with large sample sizes are needed to evaluate the effectiveness of IVB injection performed simultaneously with cataract surgery.

Association of Preoperative Hba1c Level with Incidence of New-Onset Atrial Fibrillation during Early Postoperative Period after On-Pump Coronary Artery Bypass Grafting Surgery in Diabetic Patients

Introduction: Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG) surgery, particularly in diabetic patients. Elevated preoperative HbA1c levels have been suggested as a potential risk factor for postoperative AF; however, the association remains unclear. This study aimed to investigate the association between preoperative HbA1c levels and the incidence of new-onset atrial fibrillation during the early postoperative period in diabetic patients undergoing on-pump CABG surgery in Bangladesh. Methods: This observational cross-sectional study was conducted at the Department of Cardiac Surgery, National Institute of Cardiovascular Disease, Dhaka, Bangladesh. A total of 60 diabetic patients undergoing on-pump CABG were included and divided into two groups: Group-1 (HbA1c &lt;7%, n=30) and Group-2 (HbA1c ≥7%, n=30). Data were collected using a preformed data collection sheet, and statistical analysis was performed using the chi-square test, Fisher's test, and student's t-test. Result: In this study, Group-1 (HbA1c &lt;7%) consisted of 30 patients, while Group-2 (HbA1c ≥7%) also comprised 30 patients. The mean age of Group-1 was 58.50±6.80 years, and that of Group-2 was 50.53±6.01 years (p &lt; 0.001). The distribution of preoperative variables such as single, double, and triple vessel disease, hypertension, history of antiarrhythmic drug use, and NYHA class III and IV showed no significant differences between the groups (p &gt; 0.05). However, preoperative HbA1c levels were significantly different between the two groups (6.11±0.44 in Group-1 vs. 7.98±0.55 in Group-2, p &lt; 0.001). The incidence of new-onset atrial fibrillation during the early postoperative period was significantly higher in Group-2 (63.33%) than in Group-1 (30.00%, p &lt; 0.05). A significant association was also observed between postoperative atrial fibrillation and hypertension (p &lt; 0.05). Patients in Group-2 experienced a higher rate of postoperative complications, .......

Визуальные исходы факоэмульсификации катаракты у пациентов с сахарным диабетом и различной клинической рефракцией

Purpose. To study the results of phacoemulsification (PE) in patients with diabetes mellitus (DM) depending on the anterior-posterior axis (APA) and eye refraction. Material and methods. The study involved 57 patients (57 eyes) with insulin-dependent compensated or subcompensated DM (type II). All the patients underwent PE with IOL implantation. According to the nature of refraction, the patients were divided into 3 groups: group 1 — 16 patients (16 eyes) with moderate and high myopia, group 2 — 18 people (18 eyes) with hypermetropia, group 3 — 23 patients (23 eyes) with emmetropia. Distribution of the patients according to the length of the anterior-posterior axis (APA): with moderate myopia and APA from 25.01 to 26.5 mm (7), high myopia and APA above 26.51 mm (9), with emmetropia and APA from 22.2 to 23.8 mm (23) and APA less than 22.2 mm — hypermetropics (18). Results. VA in the early and late postoperative period in patients with DM and myopic refraction after PE was higher than in patients with hypermetropia and emmetropia. Visual acuity of 0.5 and higher was observed at discharge in 75.0 % of patients with myopia (and changes in the retina in the form of diabetic retinopathy were much less frequent) than in patients with hypermetropia (50.0 %) and emmetropia (52.2 %), and in long-term follow-up in 73.3 %, 37.5 % and 36.8 %, respectively. Destabilization of diabetic retinopathy with the transition to the next stage was observed twice less often in patients with myopia (13.3 %) than in patients with hypermetropia and emmetropia (25 % and 26.3 %, respectively). Conclusion. Visual outcomes after cataract surgery in diabetic patients are strongly affected by refraction and the axial length of the eyeball. At discharge visual acuity of 0.5 and higher was observed in 75.0 % of myopic patients, 50.0 % of hypermetropics and 52.2 % of emmetropic patients; and over 3 years of follow-up — in 73.3 %, 37.5 % and 36.8 % respectively. At hospital discharge diabetic retinopathy in myopic patients was observed 4.3 times less frequently than in patients with emmetropia and hypermetropia, and its destabilization with the transition to the next stage after 3 years of postoperative follow-up was twice less often: in 13.3 % vs. 25 % and 26.3 %, respectively. Keywords: diabetes mellitus, cataract, phacoemulsification, anterior-posterior axis of the eye, refraction, myopia, visual acuity, diabetic retinopathy

"Treatment of Chronic Lower Limb Wounds and Limb- Salvage Surgery in Diabetic Patients"

"Treatment of Chronic Lower Limb Wounds and Limb- Salvage Surgery in Diabetic Patients"

VISUAL OUTCOMES IN DIABETIC PATIENTS FOLLOWING CATARACT SURGERY

Introduction:- To determine visual outcome and intraoperative and postoperative complications following cataract surgery in diabetic patients with visually signicant cataract. This is a prospective interventional Materials And Method :- study of 100 diabetic cataract patients attending outpatient department of ophthalmology in a tertiary eye care government hospital who underwent manual SICS from October 2021 to January 2022 . Intra-operative and post-operative complications were noted on follow up. Out of 100 pati Results:- ents,68% of patients had post operative visual acuity 6/12 or better. Most common complication noted intraoperatively was posterior capsular rent and post operatively was striate keratopathy (38%) which was mild in 22% cases. Other complications noted include vitreous loss, corneal edema , serous uveitis, brinous uveitis with posterior synechiae, posterior capsular opacity, pseudophakic bullous keratopathy and clinically signicant macular edema. Conclusion:- Visual improvement was seen in diabetic patient with cataract following surgery. Poor visual outcome in diabetics was mainly due to retinopathy, maculopathy or surgical complications. Monitoring for progression of diabetic retinopathy in postoperative period and timely treatment may enhance visual outcome

Effect of Pre-Operative Glycaemic Control on the Outcomes of AV Fistula Surgery in Diabetic Patients

Effect of Pre-Operative Glycaemic Control on the Outcomes of AV Fistula Surgery in Diabetic Patients

Care protocol in third molar surgery in diabetic patients: a bibliographic review

Diabetes is a metabolic disorder, caused by an increase in blood glucose, which commonly affects a large population worldwide. That is why diabetic patients in certain cases require dental care, due to their high prevalence of oral problems or the need for third molar extraction. Due to the above, a bibliographic review was carried out in the Scielo, Pubmed, and Google Scholar databases. There were no language restrictions and 130 articles were considered, according to the inclusion and exclusion criteria, 50 articles with a maximum age of 5 years were selected. As a result, it was possible to establish a care protocol for third molar surgery in diabetic patients, taking into account the different parameters that must be carried out before the surgical procedure. It is concluded that a care protocol in third molar surgery must contemplate a successful treatment plan, taking into account the most significant steps such as filling out the clinical history and preoperative glycemic control.

Outcomes of Cataract Surgery in Diabetic Patients in King Abdulaziz Medical City in 2019.

Background In this study, we aimed to analyze various complications following cataract surgery in diabetic patients and compare the outcomes of diabetic patients with comorbidities versus diabetic patients without comorbidities. Methodology This study was conducted in the adult ophthalmology department at a tertiary teaching care center. A retrospective cross-sectional chart review was conducted from January 1, 2019, to December 31, 2019. The selection was made using a non-probability consecutive sampling technique with a data collection sheet to include all male and female Saudi diabetic patients 40-80 years old who underwent cataract surgery in 2019. The data were divided into diabetic patients with comorbidities and diabetic patients without comorbidities to assess the postoperative complications in both groups. SPSS version 26 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results This study analyzed 290 diabetic patients; the most common age group was more than 65 years old (150, 51.7%), with slightly more females (147, 50.7%). A total of 181 (62.7%) patients had complications after surgery, and 255 (87.9%) patients had comorbidities. The most reported complication was corneal edema (181, 62.4%). Additionally, hypertension was the most frequently reported comorbidity (206, 71%). We also found that complications after cataract surgery were more common among females (p = 0.025). Conclusions The most prevalent postoperative cataract surgery complication was corneal edema in 181 (62.4%) patients. Despite comorbidities, no changes were reported in the prevalence of postoperative complications.

Comparison of mechanistic pathways of metabolic bariatric surgery in diabetic patients

Abstract Background and aims Metabolic bariatric surgeries are potentially efficacious treatment options in patients with type 2 diabetes mellitus (T2DM). However, previous meta-analyses focused on individual operative approaches rather than the mechanistic pathways behind different bariatric procedures. Thus, this updated network meta-analysis aimed to synthesize new evidence and comparatively evaluate the efficacy of bypass against restrictive procedures and standard first-line treatment for patients with T2DM. Methods Embase, Medline and trial registries were searched for randomized controlled trials on bariatric surgeries in patients with T2DM. A Bayesian network meta-analysis was conducted to compare between bypass, restrictive bariatric procedures, medical therapy and lifestyle intervention. Primary outcomes were T2DM remission and improvements in glycated haemoglobin (HbA1c). Secondary outcomes included changes in body mass index (BMI), lipoprotein levels and blood pressure. Results Thirty-two articles comprising 2,071 patients were included. Bypass surgery was statistically superior to restrictive procedures (RR: 2.57, 95% CrI: 1.36 to 5.43), medical therapy (RR: 35.29, 95% Crl: 10.56 to 183.23), and lifestyle intervention (RR: 40.51, 95% Crl: 5.32 to 402.59) in T2DM remission. Both bypass surgery and restrictive procedures were largely comparable in lowering HbA1c (MD: 0.02, 95% Crl: −0.03 to 0.08). In addition, bypass surgery significantly lowered BMI and blood pressure compared to other interventions. While restrictive procedures significantly increased high-density lipoproteins compared to bypass surgery, lifestyle intervention and bypass surgery were statistically superior to restrictive procedures in reducing low-density lipoproteins. Conclusion This study demonstrates that bypass surgery is superior to restrictive bariatric procedures in diabetes remission and glycaemic control. Additionally, significant metabolic advantages support the choice of bypass surgery over restrictive bariatric procedures in T2DM management. Funding Acknowledgement Type of funding sources: None.

Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6.

To investigate the cost-effectiveness of prophylactic treatments against cystoid macular edema after cataract surgery in diabetic patients. 7 ophthalmology clinics in the Netherlands and Belgium. Prospective trial-based cost-effectiveness analysis using data from a European multicenter randomized clinical trial. Diabetic patients (n = 163) undergoing uneventful cataract surgery were randomized to perioperative subconjunctival triamcinolone acetonide (n = 36), perioperative intravitreal bevacizumab (n = 36), combination treatment (n = 45), or no additional treatment (control group, n = 46). The cost analysis was performed from a healthcare perspective within a 12-week postoperative time horizon. The main effectiveness outcome was quality-adjusted life years (QALYs). The main cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER; cost per QALY). The mean total healthcare costs and QALYs were as follows: triamcinolone group €1827 (U.S. dollars [$] 2295)/0.166; bevacizumab group €2050 ($2575)/0.144; combination group €2027 ($2546)/0.166; and control group €2041 ($2564)/0.156. Bevacizumab and control treatment were most costly and least effective. The ICER was €321 984 ($404 503) per QALY for the combination group compared with that of the triamcinolone group. Assuming the willingness-to-pay as €20 000 ($25 126) per QALY, the cost-effectiveness probability was 70% and 23% in the triamcinolone and combination groups, respectively. No patient who received triamcinolone developed clinically significant macular edema (CSME). A secondary cost-effectiveness analysis based on this outcome showed a clear preference for triamcinolone. In diabetic patients, subconjunctival triamcinolone was effective in preventing CSME after cataract surgery. The cost-effectiveness analysis showed that triamcinolone is also cost-effective.

The management of cataract surgery in diabetic patients.

A cataract in the eye is a major cause of vision loss in diabetic patients, which occurs earlier and develops faster than non-diabetic patients, and often requires surgery for treatment. However, diabetic patients undergoing cataract surgery have a higher risk of intraoperative and postoperative complications than non-diabetic patients. For diabetic patients undergoing any surgery, careful perioperative assessment and management are required to reduce postoperative complications and improve surgical outcomes. Better understanding of their needs may guide perioperative practitioners to manage their care appropriately. This article presents recent evidence and guidance associated with the preoperative, intraoperative and postoperative management of diabetic patients undergoing cataract surgery and to inform perioperative practitioners of the challenges and potential complications to provide the best care and improve sight.