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Figures

Figure 1

Visual acuity in diabetic patients undergoing cataract surgery

Figure 2

Visual Acuity gain estimates per Baseline Retinopathy Extent group according to Table 3

Figure 3

Nomogram Modeling Change in Visual Acuity, Baseline to 12 Months

Abstract

Purpose

To evaluate change in best corrected visual acuity (BCVA) in patients with diabetes and diabetic retinopathy (DR) following cataract extraction (CE).

Design

Retrospective cohort study.

Subjects

Diabetic eyes of patients aged 18 or older that underwent CE at the Cleveland Clinic from 2013 to 2018.

Methods

Chart review examining visual acuities from patient visits before and after surgery, as well as optical coherence tomography (OCT) images. Statistical analysis was done using multiple linear regression models.

Main Outcome Measures

Primary endpoint was change in BCVA over the first post-operative year. Secondary endpoint was the association of the central subfield thickness (CST) at baseline with change in BCVA over this same period. Additional pre-operative factors examined were age, race, gender, laterality, insulin use, HbA1c, creatinine, blood urea nitrogen, and estimated glomerular filtration rate.

Results

Diabetic eyes without DR (n=138) and eyes with mild/moderate non-proliferative DR (NPDR; n=125), severe NPDR (n=20), and proliferative DR (PDR; n=72) were included. A year after surgery, eyes without DR gained a median of 11.0 [(Q1, Q3), (5.0, 20.0)] ETDRS letters from 65.0 (58.0, 70.0) before surgery, eyes with mild/moderate DR gained 10.0 (5.0, 22.0) from 65.0 (58.0, 76.0), eyes with severe NPDR gained 20.5 (8.0, 28.5) from 55.0 (26.0, 65.0), and eyes with PDR gained 15.0 (6.0, 29.5) from 55.0 (35.0, 61.0). Eyes without DR or mild/moderate NPDR had significantly greater improvements in VA a year after surgery as compared to eyes with severe NPDR or PDR when controlling for baseline VA, with more severe retinopathy having less expected visual acuity gain (p<0.001). This effect was not as pronounced for eyes with higher baseline VA before surgery. Length of disease most strongly related to baseline retinopathy severity (ρ=0.431, p<0.001). Baseline retinopathy is a significant driver of VA change post-surgery and significantly interacts with baseline ETDRS.

Conclusion

Cataract surgery is beneficial in the majority of patients with diabetic retinopathy without severe concurrent macular pathology. However, pre-operative visual acuity and the severity of diabetic retinopathy can limit visual outcomes.

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e Poster accepted for the American Academy of Ophthalmology Annual Meeting, 2019

Conflicts of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

 

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