Outcomes of cataract surgery in diabetic patients: results of the PanAmerican Collaborative Retina Study Group

Outcomes of cataract surgery in diabetic patients: results of the PanAmerican Collaborative Retina Study Group

Alternative title Resultados da cirurgia de catarata em pacientes diabéticos: resultado do Pan-American Collaborative Retina Study Group
Author Gallego-Pinazo, Roberto Google Scholar
Dolz-Marco, Rosa Google Scholar
Berrocal, Maria Google Scholar
Wu, Lihteh Google Scholar
Maia, Maurício Autor UNIFESP Google Scholar
Serrano, Martín Google Scholar
Alezzandrini, Arturo Google Scholar
Arévalo, J. Fernando Google Scholar
Díaz-Llopis, Manuel Google Scholar
Institution University and Polytechnic Hospital La Fe Department of Ophthalmology
University of Puerto Rico Department of Ophthalmology
Instituto de Cirugía Ocular
Universidade Federal de São Paulo (UNIFESP)
Clinica Oftalmologica Centro Caracas
Arevalo-Coutinho Foundation for Research in Ophthalmology
Universidad de Buenos Aires Cátedra de Oftalmologia
The King Khaled Eye Specialist Hospital Vitreoretinal Division
Johns Hopkins University The Wilmer Eye Institute Retina Division
University of Valencia Faculty of Medicine
Abstract Purpose:This study was designed to evaluate the visual and anatomical outcomes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies.Methods:The research design comprised of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuvant medication (Group 1), 59 patients received intraoperative bevacizumab (Group 2) and 37 patients received intraoperative triamcinolone (4 mg/0.1 ml) (Group 3).Results:The mean logMAR [± standard deviation (SD)] BCVA improved from 0.82 (± 0.43) at baseline, to 0.14 (± 0.23) at 6-month follow-up (p<0.001) in Group 1; from 0.80 (± 0.48) to 0.54 (± 0.45) (p<0.001) in Group 2; and from 1.0 (± 0.40) to 0.46 (± 0.34) (p<0.001) in Group 3. The mean central subfield thickness increased from 263.57 µm (± 35.7) at baseline to 274.57 µm (± 48.7) at 6-month follow-up (p=0.088) in Group 1; from 316.02 µm (± 100.4) to 339.56 µm (± 145.3) (p=0.184) in Group 2; and from 259.18 µm (± 97.9) to 282.21 µm (± 87.24) (p=0.044) in Group 3.Conclusion:Diabetic patients may significantly benefit from cataract surgery. This study provides evidence to support the use of intravitreal triamcinolone or bevacizumab at the time of cataract surgery in cases with pre-existent diabetic macular edema or moderate-severe non-proliferative diabetic retinopathy.

Objetivo:Avaliar os resultados visuais e anatômicos após a cirurgia de catarata em pacientes diabéticos com estratégias terapêuticas intraoperatórias diferentes.Métodos:Estudo multicêntrico, retrospectivo, de intervenção realizado em 6 centros da Argentina, Brasil, Costa Rica, Porto Rico, Espanha e Venezuela. Foram incluído 138 pacientes diabéticos com pelo menos 6 meses de seguimento apó facoemulsificação com implante de lente intraocular. Acuidade visual melhor corrigida (BCVA) e a espessura subcampo central (CST ) foram coletadas no início e em 1, 2, 3 e 6 meses de seguimento. Destes, 42 casos não foram tratadas com qualquer co-adjuvante de medicamentos intra-operatório (Grupo 1), 59 paciente receberam bevacizumab intraoperatório (Grupo 2), e 37 pacientes receberam triancinolona intraoperatória (4 mg/0,1 ml) (Grupo 3).Resultados:A média logMAR (± desvio-padrão [DP]) BCVA melhorou de 0,82 (± 0,43) no início do estudo, para 0,14 (± 0,23) aos 6 meses de seguimento (p<0,001) no Grupo 1; de 0,80 (± 0,48) para 0,54 (± 0,45) (p<0,001) no Grupo 2; e de 1,0 (± 0,40) para 0,46 (± 0,34) (p<0,001) no Grupo 3. A CST média aumentou de 263,57 µm (± 35,7) na linha de base para 274,57±48,7 µm em 6 meses acompanhamento (p=0,088) no Grupo 1; de 316,02 µm (± 100,4), para 339,56 µm (± 145,3) (p=0,184) no Grupo 2; e de 259,18 µm (± 97,9), para 282,21 µm (±87,24) (p=0,044) no grupo 3.Conclusões:Pacientes diabéticos podem se beneficiar significativamente da cirurgia de catarata. Este estudo parece fornecer evidências para apoiar o uso de triancinolona intravítrea ou bevacizumab no momento da cirurgia de catarata em casos com edema macular diabético preexistente (DME) ou retinopatia diabética não-proliferativa moderada a grave.
Keywords Diabetic retinopathy
Macular edema
Cataract extraction
Intraoperative care
Phacoemulsification
Lens implantation, intraocular
Antibodies, monoclonal
Multicenter study
Retinopatia diabética
Edema macular
Extração de catarata
Cuidados intraoperatórios
Facoemulsificação
Implante de lente intraocular
Anticorpos monoclonais
Estudo multicêntrico
Language English
Date 2014-12-01
Published in Arquivos Brasileiros de Oftalmologia. Conselho Brasileiro de Oftalmologia, v. 77, n. 6, p. 355-359, 2014.
ISSN 0004-2749 (Sherpa/Romeo, impact factor)
1678-2925 (Sherpa/Romeo, impact factor)
Publisher Conselho Brasileiro de Oftalmologia
Extent 355-359
Origin http://dx.doi.org/10.5935/0004-2749.20140089
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000348589700004
SciELO ID S0004-27492014000600355 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/8690

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