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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Is There a Safe Glycemic Threshold for Cataract Surgery?

Zain S Hussain1, Ahmed F Shakarchi1, Muhammad Z Chauhan1

  • 1From the Department of Ophthalmology (Z.H., A.S., M.C., D.J., A.S.), Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

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Cataract surgery in diabetic patients did not show increased risks for post-operative endophthalmitis or serious systemic events, regardless of hemoglobin A1c (HbA1c) levels. These findings support individualized risk assessment for surgical fitness in diabetic individuals.

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Health Outcomes Research

Background:

  • Diabetes mellitus is a prevalent condition affecting vision, with cataract formation being a common complication.
  • Elevated hemoglobin A1c (HbA1c) levels in diabetic patients may influence surgical outcomes.
  • The safety of elective procedures like cataract surgery in diabetic populations requires careful evaluation.

Purpose of the Study:

  • To investigate the association between cataract surgery and 30-day post-operative endophthalmitis (POE) in diabetic patients with varying HbA1c levels.
  • To assess the risk of serious systemic adverse events following cataract surgery in diabetic patients stratified by HbA1c.
  • To compare outcomes in diabetic patients undergoing cataract surgery with non-diabetic controls and diabetic controls not undergoing surgery.

Main Methods:

  • A retrospective, longitudinal cohort study utilizing a global federated electronic health record database.
  • Inclusion of adult patients (≥18 years) with type 1 or type 2 diabetes mellitus who underwent phacoemulsification cataract surgery.
  • Analysis of 30-day incidence of POE and serious systemic adverse events (mortality, stroke, major cardiovascular events), with hazard ratios calculated using Cox proportional hazards models.

Main Results:

  • No significant difference in the 30-day risk of POE was observed across different HbA1c levels compared to non-diabetic controls.
  • Hazard ratios for POE ranged from 0.62 (HbA1c <7%) to 2.85 (HbA1c >11.3%), with no statistically significant elevations.
  • The 30-day incidence of serious systemic adverse events did not significantly differ across HbA1c levels compared to controls, with similar findings at 90 days.

Conclusions:

  • Cataract surgery in diabetic patients does not appear to elevate the risk of post-operative endophthalmitis or serious systemic adverse events across the spectrum of HbA1c levels.
  • Preoperative HbA1c level alone should not be a contraindication for deferring cataract surgery.
  • Individualized risk assessment is crucial for determining surgical candidacy in diabetic patients undergoing cataract surgery.