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Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy.
Ophthalmol Retina. 2020 04; 4(4):351-360.OR

Abstract

PURPOSE

To evaluate change in best-corrected visual acuity (BCVA) in patients with diabetes and diabetic retinopathy (DR) after cataract extraction (CE).

DESIGN

Retrospective cohort study.

PARTICIPANTS

Diabetic eyes of patients 18 years of age or older that underwent CE at the Cleveland Clinic from 2012 through 2018.

METHODS

Chart review examining visual acuities from patient visits before and after surgery, as well as OCT images. Statistical analysis was carried out using multiple linear regression models.

MAIN OUTCOME MEASURES

The primary end point was change in BCVA during the first postoperative year. The secondary end point was the association of central subfield thickness at baseline with change in BCVA. Additional preoperative factors examined were age, race, gender, laterality, insulin use, hemoglobin A1c, creatinine, blood urea nitrogen, and estimated glomerular filtration rate.

RESULTS

Diabetic eyes without DR (n = 138) and eyes with mild/moderate nonproliferative DR (NPDR; n = 125), severe NPDR (n = 20), and proliferative DR (PDR; n = 72) were included. A year after surgery, eyes without DR gained a median of 11.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (interquartile range [IQR], 5.0-20.0) from 65.0 (IQR, 58.0-70.0) before surgery, eyes with mild or moderate DR gained 10.0 letters (IQR, 5.0-22.0) from 65.0 (IQR, 58.0-76.0), eyes with severe NPDR gained 20.5 letters (IQR, 8.0-28.5) from 55.0 (IQR, 26.0-65.0), and eyes with PDR gained 15.0 letters (IQR, 6.0-29.5) from 55.0 (IQR, 35.0-61.0). Eyes without DR or mild or moderate NPDR showed significantly greater improvements in VA 1 year after surgery compared with eyes with severe NPDR or PDR when controlling for baseline visual acuity (VA), with eyes with more severe DR showing less expected VA gain (P < 0.001). Length of disease most strongly related to baseline DR severity (ρ = 0.431; P < 0.001).

CONCLUSIONS

Cataract surgery is beneficial in most patients with DR without severe concurrent macular pathologic features. However, preoperative VA and the severity of DR can limit visual outcomes.

Authors+Show Affiliations

Case Western Reserve University School of Medicine, Cleveland, Ohio.Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Case Western Reserve University School of Medicine, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.Case Western Reserve University School of Medicine, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio.Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: talcotk@ccf.org.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32111544

Citation

Han, Michael M., et al. "Visual Acuity Outcomes After Cataract Extraction With Intraocular Lens Implantation in Eyes With Diabetic Retinopathy." Ophthalmology. Retina, vol. 4, no. 4, 2020, pp. 351-360.
Han MM, Song W, Conti T, et al. Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy. Ophthalmol Retina. 2020;4(4):351-360.
Han, M. M., Song, W., Conti, T., Conti, F. F., Greenlee, T., Hom, G., Briskin, I. N., Singh, R. P., & Talcott, K. E. (2020). Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy. Ophthalmology. Retina, 4(4), 351-360. https://doi.org/10.1016/j.oret.2019.12.018
Han MM, et al. Visual Acuity Outcomes After Cataract Extraction With Intraocular Lens Implantation in Eyes With Diabetic Retinopathy. Ophthalmol Retina. 2020;4(4):351-360. PubMed PMID: 32111544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visual Acuity Outcomes after Cataract Extraction with Intraocular Lens Implantation in Eyes with Diabetic Retinopathy. AU - Han,Michael M, AU - Song,Weilin, AU - Conti,Thais, AU - Conti,Felipe F, AU - Greenlee,Tyler, AU - Hom,Grant, AU - Briskin,Isaac N, AU - Singh,Rishi P, AU - Talcott,Katherine E, Y1 - 2020/01/07/ PY - 2019/10/04/received PY - 2019/12/26/revised PY - 2019/12/27/accepted PY - 2020/3/1/pubmed PY - 2021/5/19/medline PY - 2020/3/1/entrez SP - 351 EP - 360 JF - Ophthalmology. Retina JO - Ophthalmol Retina VL - 4 IS - 4 N2 - PURPOSE: To evaluate change in best-corrected visual acuity (BCVA) in patients with diabetes and diabetic retinopathy (DR) after cataract extraction (CE). DESIGN: Retrospective cohort study. PARTICIPANTS: Diabetic eyes of patients 18 years of age or older that underwent CE at the Cleveland Clinic from 2012 through 2018. METHODS: Chart review examining visual acuities from patient visits before and after surgery, as well as OCT images. Statistical analysis was carried out using multiple linear regression models. MAIN OUTCOME MEASURES: The primary end point was change in BCVA during the first postoperative year. The secondary end point was the association of central subfield thickness at baseline with change in BCVA. Additional preoperative factors examined were age, race, gender, laterality, insulin use, hemoglobin A1c, creatinine, blood urea nitrogen, and estimated glomerular filtration rate. RESULTS: Diabetic eyes without DR (n = 138) and eyes with mild/moderate nonproliferative DR (NPDR; n = 125), severe NPDR (n = 20), and proliferative DR (PDR; n = 72) were included. A year after surgery, eyes without DR gained a median of 11.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (interquartile range [IQR], 5.0-20.0) from 65.0 (IQR, 58.0-70.0) before surgery, eyes with mild or moderate DR gained 10.0 letters (IQR, 5.0-22.0) from 65.0 (IQR, 58.0-76.0), eyes with severe NPDR gained 20.5 letters (IQR, 8.0-28.5) from 55.0 (IQR, 26.0-65.0), and eyes with PDR gained 15.0 letters (IQR, 6.0-29.5) from 55.0 (IQR, 35.0-61.0). Eyes without DR or mild or moderate NPDR showed significantly greater improvements in VA 1 year after surgery compared with eyes with severe NPDR or PDR when controlling for baseline visual acuity (VA), with eyes with more severe DR showing less expected VA gain (P < 0.001). Length of disease most strongly related to baseline DR severity (ρ = 0.431; P < 0.001). CONCLUSIONS: Cataract surgery is beneficial in most patients with DR without severe concurrent macular pathologic features. However, preoperative VA and the severity of DR can limit visual outcomes. SN - 2468-6530 UR - https://www.unboundmedicine.com/medline/citation/32111544/Visual_Acuity_Outcomes_after_Cataract_Extraction_with_Intraocular_Lens_Implantation_in_Eyes_with_Diabetic_Retinopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2468-6530(19)30690-6 DB - PRIME DP - Unbound Medicine ER -