Defining a Cataract Surgery Protocol in Diabetic Patients: A Pilot Study

Area of Science:

• Ophthalmology
• Diabetology
• Surgical Innovation

Background:

• Cataract surgery in Type II diabetes mellitus (T2DM) patients poses increased risks of complications.
• Optimizing surgical protocols and patient selection criteria is crucial for mitigating adverse outcomes.
• A defined protocol may enhance safety and efficacy in this high-risk population.

Purpose of the Study:

• To evaluate the safety and efficacy of cataract surgery in T2DM patients using a specific preoperative evaluation and selection protocol.
• To assess visual acuity, refractive outcomes, and complication rates in diabetic patients undergoing cataract surgery.

Main Methods:

• A prospective, non-randomized pilot study involving T2DM patients with visually significant cataracts.
• Strict preoperative selection criteria included Diabetic Retinopathy Severity Scale (DRSS) classification, stable ocular coherence tomography, and 3-month anti-VEGF treatment-naive status.
• Patients underwent phacoemulsification with monofocal IOL implantation, without intra-operative corticosteroids or anti-VEGF, followed by a standardized post-operative regimen.

Main Results:

• At 3 months post-surgery (n=25 eyes), the visual acuity efficacy index was 1.32.
• Clinical cystoid macular edema (CME) incidence was 16%.
• Diabetic macular edema (DME) recurrence or new onset occurred in 8.0% of eyes, with higher DRSS and prior anti-VEGF treatment being significant risk factors.

Conclusions:

• Rigorous patient selection and adherence to a robust preoperative protocol can lead to excellent visual outcomes in diabetic cataract surgery patients.
• This approach demonstrates manageable complication rates, supporting its clinical utility.