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CATARACT SUEGRY AND DIABETES

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Indications of surgery: 1) Visual loss 2)Surveillance of retinopathy 3)Laser therapy

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PREOPERATIVE CONSIDERATIONS : VA Slitlamp Exam Fundoscopy Sonography

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SURGICAL TECHNIQUE: Phaco. Large Capsulorrhexis Large Optic Diameter Lenses Acrylic Lenses

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POST OPERATIVE MANAGEMENT: 1.Steroids 2.NSAID 3.Close Post Operative Fundocopy

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Decreased vision after surgery by: - Severe fibrinous uveitis - Capsular opacity - NVI - Macular edema - Deterioration of retinopathy

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Cataract surgery and progression of diabetic retinal disease Jaffe et al (1992): Nonproliferative diabetic retinopathy progressed following ECCE

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Romero-Aroca et al.(2006): no significant differences in the rates of diabetic retinopathy progression with and without cataract surgery

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cataract surgery causes progression of diabetic macular edema Biro and Balla (2009): Increased macular thickening in the first 2 months after surgery, with no significant difference between diabetics and normal controls

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As a whole, there is no clear evidence that phacoemulsification surgery causes progression of diabetic retinopathy or diabetic macular edema, particularly in patients with low-risk or absent diabetic retinopathy

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PERI-OPERATIVE TRIAMCINOLONE Kim et al. (2008): They found no significant difference in diabetic retinopathy progression, visual acuities, or central macular thickness at 6 months postoperatively

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INTRAVITREAL TRIAMCINOLONE No long-term benefit of in comparison with focal/grid photocoagulation in eyes with diabetic macular edema

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INTRAVITREAL BEVACIZUMAB AFTER CATARACT SURGERY The study makes no comment on any differences in acuity improvement between the treated and untreated groups

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PANRETINAL PHOTOCOAGULATION AND CATARACT SURGERY TIMING The PRP-first group had significantly higher levels of aqueous flare intensity that persisted until 3 months post phacoemu- lsification

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PRP-first with higher aqueous flare intensities,worse visual outcomes and macular edema progression

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CONCLUSION: adjuvant anti-inflammatory or anti-VEGF agents at the time of cataract surgery show improved outcomes of acuity and macular edema primarily in patients with preexisting macular edema at the time of surgery

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CATARACT SURGERY AND GLAUCOMA

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CATARACT SURGERY IN ANGLE CLOSURE GLAUCOMA UBM and anterior segment OCT have recently confirmed that a thickened and anteriorly positioned lens may be involved in the pathogenesis of PACG

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Plateau iris mechanisms can comprise up to 62% of eyes with anatomically narrow angles in some populations

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These findings suggest that lens extraction may be advantageous in eyes with PACG and may lead to a significant IOP reduction

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CATARACT SURGERY IN OPEN ANGLE GLAUCOMA Cataract surgery Trabeculectomy Cataract extraction and trabeculectomy Alternative surgical technique to lower IOP

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severity of glaucoma visual needs Experience and skill of the surgeon

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CATARACT SURGERY ALONE Glaucomatous damage is mild IOP is within the target range well tolerated medications

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TRABECULECTOMY ALONE Patients with uncontrolled severe glaucoma despite maximum tolerable medical therapy should benefit from trabeculectomy alone

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COMBINED CATARACT SURGERY AND TRABECULECTOMY In the presence of a visually significant cataract and uncontrolled glaucoma

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CONCLUSION: important factors 1.Age 2. Disease Severity 3.Ability To Tolerate Medications 4.Desired IOP

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THE END