Diabetic maculopathy and cataract surgery

Patients with diabetic mellitus have an increased risk of developing cataract. Many such patients have pre-existing diabetic retinopathy at the time of cataract surgery Although more than 90% of the patients who have no pre-existing diabetic retinopathy carry a good visual prognosis and eventually have 20/40 or better visual acuity, nearly one-third of patients with pre-existing retinopathy may show retinopathy progression. Postoperative angiographic macular edema is more common in patients with diabetes but resolves spontaneously in patients with no or minimal diabetic retinopathy. In patients with moderate to severe NPDR or more, clinically significant macular edema tends to persist, may arise de-novo, or even worsen after cataract surgery. Patients with diabetes need a preoperative characterization of their retinopathy and a thorough discussion with the patient about the need for cataract surgery, and the risk of progression of retinopathy is mandated. Currently, early surgery is favored before the development of significant diabetic retinopathy rather than wait for the cataract to become denser. All efforts should be made to stabilize diabetic retinopathy with appropriate laser treatment before cataract surgery. All diabetic patients need close observation for at least 6 months following surgery to intervene with laser photocoagulation as and when required to prevent visual loss from diabetic maculopathy and other consequences of diabetic retinopathy.