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

Cataract surgery in patients with Type II diabetes mellitus (T2DM) can lead to complications. A well-defined surgical protocol that optimizes the procedure and applies strict selection criteria may reduce the risk of adverse outcomes. We evaluate safety and efficacy outcomes in diabetic patients undergoing cataract surgery by employing a specific protocol for preoperative evaluation and surgery selection.

A prospective, non-randomized pilot study was performed on patients with T2DM and visually significant cataract. Patients adhered to a strict preoperative selection protocol including classification as per Diabetic Retinopathy Severity Scale (DRSS), stable ocular coherence tomography, and anti-VEGF treatment-naive for a minimum 3 months before surgery. Patients underwent phacoemulsification surgery with monofocal intraocular lens implantation (IOL) without intra-operative corticosteroid or anti-VEGF injection and undertook the same post-operative regimen. Final patient evaluation was performed at 3 months to evaluate vision, refractive and safety outcomes.

At 3 months (n=25 eyes), the visual acuity efficacy index was 1.32. The incidence of clinical CME was 16%. An increase from baseline CMT of 1 micron to 25 microns was seen in 53% of eyes with an increase between 26 microns to 50 microns seen in 20% of eyes. A recurrence or new onset of DME was diagnosed in 8.0% of eyes. Factors found to increase the recurrence of DME included higher DRSS at baseline (p=0.032) and previous treatment with anti-VEGF (p<0.001).

Patient selection with adherence to a robust preoperative protocol can result in excellent visual outcomes and manageable complication rates.