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Article Type

Original Study

Abstract

Objectives The aim of the study was to evaluate the progression of diabetic retinopathy (DR) after phacoemulsification in cataractous diabetic patients and determine whether complicated cases of phacoemulsification with opening of the posterior capsule during surgery affect the progression of DR. Background Diabetes is the most common risk factor for development of cataract. The visual outcome of cataract surgery in diabetic patients depends on the severity of retinopathy. Cataract may prevent the recognition or treatment of sight-threatening retinopathy before surgery, and, after surgery, vision may be impaired by severe fibrinous uveitis, capsular opacification, anterior segment neovascularization, macular oedema and deterioration of retinopathy, probably due to interruption of the blood-retinal barrier. Materials and methods This study includes 40 cataractous diabetic patients, who underwent detailed history taking, full ophthalmic examination, fundus fluorescein angiography and optical coherence tomography before and after phacoemulsification. The patients were divided into two groups. Group A: this group included 20 patients selected from among uncomplicated phacoemulsification surgeries with polymethyl methacrylate or acrylic posterior chamber intraocular lens implantation. Group B: this group included 20 patients selected from among phacoemulsification surgeries with accidental opening of the posterior capsule during surgery and subsequent removal of the anterior vitreous face with or without intraocular lens implantation in the same session. Results DR showed a progression rate of 10% in group A compared with 20% in group B. The difference between groups as regards DR progression was highly significant. The statistically significantly higher progression rate in DR observed in complicated cases (group B) may be explained by interruption of the blood-retinal barrier. Conclusion Uncomplicated phacoemulsification does not cause acceleration of DR postoperatively. Any progression that is observed postoperatively represents the natural history of the disease. Posterior capsular tear during cataract surgery in diabetic patients leads to statistically significant higher rates of macular oedema, progression of DR and increase in foveal thickness. These events may be related to interruption of the blood-retinal barrier after a posterior capsular tear and the subsequent increased incidence of postoperative inflammation in diabetic patients with diffusion of inflammatory mediators from the anterior segment to the posterior segment. These inflammatory mediators increase the vascular permeability of the retinal capillaries with subsequent macular oedema and increase in foveal thickness.

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