Clinical Guidelines for Diabetic Retinopathy: A Summary
Clinical Guidelines for Diabetic Retinopathy: A Summary
Cataract is more common in diabetic patients but cataract surgery carries a higher risk of complications (OR 1.8) in this population (Level B). Cataract surgery should be performed with special attention to cortical clean up, avoiding lengthy procedures so as to reduce risks of uveitis and cystoid macular oedema (Level B). Serious postoperative complications are less frequent with modern phacoemulsification techniques. In patients with diabetes, endophthalmitis is likely to be more severe and leads to poorer visual outcome. Hence, surgeons need to pay specific attention to known surgical risk factors such as pre-existing ocular surface infection, wound construction, minimising tissue trauma, and avoiding surgical complications (Level A). Good diabetic control can help reduce postoperative complications (Level B).
Pre-existing macular oedema should be treated preoperatively, where possible. If this is not possible, intravitreal anti-VEGF or steroid injection (preferably preservative-free form) may be given at the conclusion of the cataract operation (Level A). Pre-existing proliferative retinopathy should be treated either preoperatively or at the conclusion of cataract procedure (Level A). DR may progress more rapidly following cataract surgery, hence it is advisable to monitor the eyes with pre-existing retinopathy closely in the postoperative period (Level A).
Cataract
Cataract is more common in diabetic patients but cataract surgery carries a higher risk of complications (OR 1.8) in this population (Level B). Cataract surgery should be performed with special attention to cortical clean up, avoiding lengthy procedures so as to reduce risks of uveitis and cystoid macular oedema (Level B). Serious postoperative complications are less frequent with modern phacoemulsification techniques. In patients with diabetes, endophthalmitis is likely to be more severe and leads to poorer visual outcome. Hence, surgeons need to pay specific attention to known surgical risk factors such as pre-existing ocular surface infection, wound construction, minimising tissue trauma, and avoiding surgical complications (Level A). Good diabetic control can help reduce postoperative complications (Level B).
Pre-existing macular oedema should be treated preoperatively, where possible. If this is not possible, intravitreal anti-VEGF or steroid injection (preferably preservative-free form) may be given at the conclusion of the cataract operation (Level A). Pre-existing proliferative retinopathy should be treated either preoperatively or at the conclusion of cataract procedure (Level A). DR may progress more rapidly following cataract surgery, hence it is advisable to monitor the eyes with pre-existing retinopathy closely in the postoperative period (Level A).
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