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Rapid Glycemic Control Seen Detrimental Before Cataract Surgery

Posted: Saturday, January 28, 2006

Dr. Chikako Suto from Tokyo Women's Medical University and colleagues determined the effect of perioperative glycemic control on progression of diabetic retinopathy and maculopathy in 87 type 2 diabetics who had phacoemulsification cataract surgery performed on one eye by a single surgeon.

Twenty-seven of the patients had poor glycemic control before surgery and underwent rapid preoperative glycemic correction; 30 had poor preoperative glycemic control that was not corrected prior to surgery; and 30 patients had good preoperative glycemic control.

The investigators compared the grade of diabetic retinopathy and maculopathy in the operated eye and the non-operated eye before surgery and for 12 months after surgery.

Overall, there were no significant between-group differences in the rate of progression of retinopathy one year after surgery. Postoperative progression of retinopathy was seen in 30% of the rapid glycemic control group, 17% of the poor glycemic control group, and 13% of the good control group.

However, according to Dr. Suto and colleagues, the rate of progression of diabetic maculopathy was significantly higher (33%) in patients who underwent rapid glycemic correction prior to surgery compared with the other two groups (p = 0.02).

Patients in the rapid control group with moderate to severe nonproliferative diabetic retinopathy before surgery had significantly higher rates of progression of diabetic retinopathy (p = 0.002) and maculopathy (p= 0.008) after surgery.

Dr. Suto and colleagues conclude, based on their findings, that rapid reduction of blood glucose levels "should not be advocated" for patients with moderate to severe nonproliferative diabetic retinopathy and maculopathy before cataract surgery.

Source: Diabetes In Control