Diabetic cataract removal: postoperative progression of maculopathy--growth factor and clinical analysis

Diabetic cataract extraction can be frequently complicated by macular oedema, progression of retinopathy, or development of iris neovascularisation. The pathogenesis of these complications may be the result of changes in the concentration of angiogenic and anti-angiogenic cytokines in the immediate postoperative period. The study aims to prospectively analyse this.

Uneventful phacoemulsification with intraocular lens implant was performed in seven eyes of six patients with diabetic retinopathy ranging from severe non-proliferative to quiescent proliferative. Patients were reviewed 1 day, 1 week, 1 month, and 3 months after surgery with fundus fluorescein angiography (FFA) and aqueous sampling. Each sample was analysed for VEGF, HGF, Il-1 beta (pg/ml), and PEDF (microg/ml) by sandwich ELISA.

Clinically significant macular oedema (CSMO) occurred in one patient although increased macular hyperfluorescence occurred in three patients on FFA at 1 month. VEGF 165 concentration increased 1 day after surgery from a median baseline of 68 pg/ml (range 22-87 pg/ml) to 723 pg/ml (range 336-2071) at day 1. By 1 month it had decreased to 179 (range 66-811 pg/ml). HGF concentrations steadily increased over the month while IL-1 beta and PEDF concentrations demonstrated an acute rise on day 1 after surgery and then IL-1beta returned to baseline concentrations while PEDF decreased to below baseline.

These results confirm altered concentrations of angiogenic and antiangiogenic growth factors after cataract surgery, which may induce subclinical and clinical worsening of diabetic maculopathy.