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FACTOR AFFECTING VISUAL OUTCOME OF CATARACT SURGERY IN DIABETIC PATIENT- A RETROSPECTIVE STUDY

FACTOR AFFECTING VISUAL OUTCOME OF CATARACT SURGERY IN DIABETIC PATIENT- A RETROSPECTIVE STUDY. Dr VISHNUKANT GHONSIKAR 3 rd YR RESIDENT L.T.M.M.C & L.T.M.G.H [FP 626] SERIAL NO- 25 CO-AUTHOR : DR NAYANA POTDAR,DR CHHAYA SHINDE,DR ASIF VIRANI,DR POOJA. PURPOSE.

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FACTOR AFFECTING VISUAL OUTCOME OF CATARACT SURGERY IN DIABETIC PATIENT- A RETROSPECTIVE STUDY

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  1. FACTOR AFFECTING VISUAL OUTCOME OF CATARACT SURGERY IN DIABETIC PATIENT- A RETROSPECTIVE STUDY Dr VISHNUKANT GHONSIKAR 3rd YR RESIDENT L.T.M.M.C & L.T.M.G.H [FP 626] SERIAL NO- 25 CO-AUTHOR : DR NAYANA POTDAR,DR CHHAYA SHINDE,DR ASIF VIRANI,DR POOJA

  2. PURPOSE • To determine if phacoemulsification would decrease the risk of progression for eyes with all levels of preoperative retinopathy • To determine if prolonged surgical time affects progression of retinopathy • To determine effect (if any) of surgeon experience and operative complications

  3. METHOD & MATERIAL • 150 eyes of 119 patients (79 F, 40 M) • Average age 62.2 years • 67% on insulin • 68% hypertensive, 22% renal disease, 41% atheroslcerotic cardiovascular disease • 105 resident cases, 45 private • Average preoperative vision was20/100 (range from 20/30 to HM) • Patient characteristics were similar between resident and private groups • Private cases were performed by one surgeon, resident cases were supervised

  4. METHOD & MATERIAL 1. Medical history 2. Best corrected pre- and postoperative visual acuity 3. Retinopathy stage 4. Duration of surgery 5. Operative complications • Statistical analysis of data using chi-square, t-test, univariate/multivariate logistic regression analysis performed

  5. PRE-OPERATIVE LASER • Preoperative photocoagulation performed on 53 eyes • 8 focal/grid, 32 panretinal photocoagulation, 13 both • All eyes had stable retinopathy preoperatively except two, which had active (CSDME) that could not be treated due to cataract • Three eyes had dense cataract so preoperative retinopathy could not be judged • 37% (56) had no preoperative retinopathy • 33% (49) had (NPDR) • 30% (45) had proliferative diabetic retinopathy (PDR)

  6. INTRAOPERATIVE DATA • Phacoemulsification with PC IOL in 149; • Phacoemulsification with AC IOL in 1 • Posterior capsular tear in 18 (12%) 16 resident 2 private (p = .03) • SURGICAL TIME • Overall average was 53 minutes • Average time for resident cases was 62 minutes and for private cases, 29 minutes (.0001) • Longer cases statistically associated with the development of a capsular tear

  7. POST-OPERATIVE DATA • Retinopathy progression • 25% (37) demonstrated retinopathy progression 5 eyes developed new retinopathy (1 CSDME) 26 eyes developed new or recurrent macular edema 6 eyes developed new or recurrent active PDR (3 with CSDME also) • The difference in progression between resident and private eyes was statistically significant (p = .035) • Eyes that progressed had a final visual outcome of 0.48 logMar (20/60) compared to 0.26 logMar (>20/40) for those eyes without progression (p = .0056)

  8. RESULT • Significant improvement in visual acuity for all levels of preoperative retinopathy • Visual acuity improved by at least 2 lines in 78% (117 eyes) • 20/40 or better in 62% • 20/25 or better in 47% • Overall average change of 4 lines on chart • Vision was 20/200 or worse in 9% (14) of eyes • Presence of NPDR preoperatively was predictive of retinopathy progression (p=.006)

  9. DISCUSSION • Good visual outcomes with phacoemulsification surgery are possible in patients with diabetes mellitus • Visual results are similar to those presented in other previously published series • Retinopathy progression in 25%, lower than many series of phaco or ECCE 1. Antcliff, Eye (1996): 34% 2. Pollack, BJO (1991): 38% 3. Henricsson, BJO (1996): 43% • Jaffe (1992) noted that patients with NPDR preoperatively had a 37% rate of progression; our study revealed a rate of 45%

  10. RESIDENT CASES • Higher level of retinopathy progression with resident surgery • Resident surgery longer • Higher complication rate • Surgery in diabetic patients should probably not be performed by beginning level residents

  11. ADDITIONAL HIGHLIGHT • Eyes that progressed had longer surgery • Progression was with restricted visual outcome • NPDR preoperatively is associated with progression postoperatively • Progression of retinopathy may be related to intraocular inflammation given the high rate of worsening seen after surgery or noted in conjunction with infectious and/or inflammatory states • Question: Might more aggressive postoperative inflammatory control decrease risk?

  12. RECOMMENDATION • Diabetic patients with any retinopathy should be counseled as to the real possibility of progression after cataract extraction • Patients should understand that their visual outcome may not be equal to that of nondiabetic patients • NPDR, longer surgery, and surgical inexperience lead to progression of retinopathy after cataract extraction • Aggressive control of preoperative retinopathy and surgical and postoperative inflammation may result in a decreased incidence of progression

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