Combined Phacoemulsification and Intravitreal Dexamethasone Is an Effective Option for High-Risk Diabetic Macula Oedema Patients

Journal article

Objective Cataract surgery in diabetic patients carries an increased risk of post-operative macula oedema, particularly in those with a history of diabetic macula oedema (DMO) treatment or DMO at the time of surgery. We investigated whether simultaneous phacoemulsification with intravitreal Ozurdex^® reduces the risk of developing new, or deteriorating current, DMO. Methods We conducted a retrospective review of 79 consecutive 'high-risk' diabetic patients who underwent phacoemulsification with intraocular lens insertion and intravitreal Ozurdex^® implantation immediately subsequently. 'High risk' was defined as diabetic patients with prior treatment history for DMO or current DMO. Central macula thickness (CMT), best-corrected visual acuity and intraocular pressure were recorded pre-operatively, at two to four weeks and at three months post-operatively. A significant change in CMT was defined as a change of ≥0.1 LogOCT units. Results The mean age was 72.6 years; 52% were males. The mean pre-operative CMT was 365um. Thirty-seven per cent (37%) patients had prior DMO history that had resolved; 63% had confirmed DMO in surgery. Two to four weeks post-operatively, 82% of patients had stable CMT and 18% showed improvement. No patients deteriorated. Three months post-operatively, 48% of patients had stable CMT relative to pre-operative measurements, 38% improved, and 14% deteriorated. Analysis of variance (ANOVA) indicated no significant differences in response with demographical or pathological factors, including diabetic retinopathy grade and treatment history. Conclusion Phacoemulsification surgery combined with Ozurdex^® insertion at the end of the procedure is a highly effective strategy for protecting against the formation of new, or the deterioration of current DMO, in the highest risk diabetic patients undergoing cataract surgery.

Authors: Thirunavukarasu, AJ; Malem, A; Mourtzoukos, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: Cureus: Journal of Medical Science
• Volume: 13
• Issue: 8
• Pages: e17603-e17603
• Publication date: 2021-08-31
• DOI: 10.7759/cureus.17603
• EISSN: 2168-8184
• ISSN: 2168-8184
• Language: English
• Keywords: Visual acuity; Intraocular pressure; Phacoemulsification; Retrospective cohort study; Medicine; Diabetes mellitus; Dexamethasone; Ophthalmology; Endocrinology; Diabetic retinopathy; Surgery; Internal medicine