The order in which panretinal laser photocoagulation and cataract surgery were performed had no effect on postoperative retinopathy, but the rate of progression of macular edema decreased in the surgery-first group, according to a small, randomized, prospective study of diabetes patients.
Up to 25% of all cataract surgery is performed on diabetic patients, according to Dr. Chikako Sutto and her colleagues in the June issue of the Journal of Cataract and Refractive Surgery. Such patients frequently have diabetic retinopathy, which requires treatment with panretinal laser photocoagulation (PRP).
Previous research in an era of more invasive surgery indicated that better results were obtained when PRP was performed prior to surgery. To test whether the same holds true in today's era of less invasive surgery, the researchers from Tokyo and Saitama (Japan), evaluated outcomes in contralateral eyes of patients with diabetic retinopathy who had PRP first followed by cataract surgery in one eye, and cataract surgery followed by PRP in the other.
A total of 58 eyes in 29 patients with similar bilateral cataracts and severe nonproliferative or early proliferative diabetic retinopathy were randomly assigned to one eye treated with PRP first, followed by surgery, and the other with surgery first, followed by PRP. The main outcome measured was best-corrected visual acuity (BCVA) 12 months after surgery. Secondary outcome measures were laser parameters, progression of retinopathy and macular edema, and aqueous flare intensity.
Patients had a mean age of 66 years and all had type 2 diabetes, with a mean duration of diabetes of 12.2 years; nine of the patients were men. Patient treatment regimens were diet only (9 patients), oral hypoglycemic agent (10), and insulin therapy (17). There were no significant differences between treatment groups in baseline characteristics.
The percentage of eyes with a BCVA of 20/40 or better was statistically significantly higher in the surgery-first group (96.6%) than in the PRP-first group (69%, P = .012), and the rate of macular edema progression was significantly decreased in the surgery-first group (P = .033). Laser parameters, progression of retinopathy, and aqueous flare intensity were not significantly different between the two groups (J. Cataract Refract. Surg. 2008;34:1001-6).
“Our results suggest that if small-incision cataract surgery is performed first, PRP can be performed in time to prevent diabetic retinopathy from worsening and that potential treatment of macular edema must be considered when determining the timing of cataract surgery,” the authors concluded.
The authors reported that they had no financial interest in any material or method mentioned.