Effect of perioperative glycemic control in progression of diabetic retinopathy and maculopathy

Arch Ophthalmol. 2006 Jan;124(1):38-45. doi: 10.1001/archopht.124.1.38.

Abstract

Objective: To evaluate the contribution of perioperative glycemic control to progression of diabetic retinopathy and maculopathy.

Methods: Postoperative progression of diabetic retinopathy and maculopathy were compared in 87 patients with type 2 diabetes mellitus who underwent monocular phacoemulsification cataract surgery performed by a single surgeon. Twenty-seven patients had had poor glycemic control preoperatively and underwent rapid preoperative glycemic correction; 30 patients had poor control preoperatively that was not corrected postoperatively; and 30 patients had good preoperative glycemic control. The grade of diabetic retinopathy and maculopathy in the operated-on eye and the fellow eye was assessed preoperatively and for 12 months postoperatively.

Results: There were no significant differences in the progression rate of diabetic retinopathy among the 3 groups (P = .27). However, the progression rate of diabetic maculopathy was significantly higher in the group that underwent rapid control than in the other 2 groups (P = .02). Patients with moderate to severe nonproliferative diabetic retinopathy preoperatively in the rapid control group had significantly higher progression rates of diabetic retinopathy and maculopathy (P = .002 and .008, respectively).

Conclusions: Rapid preoperative glycemic control should be avoided in patients with moderate to severe nonproliferative diabetic retinopathy because it may increase the risk of postoperative progression of retinopathy and maculopathy.

MeSH terms

  • Blood Glucose / metabolism*
  • Diabetic Retinopathy / etiology
  • Diabetic Retinopathy / physiopathology*
  • Diabetic Retinopathy / surgery
  • Disease Progression
  • Female
  • Fluorescein Angiography
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Laser Coagulation
  • Lens Implantation, Intraocular / adverse effects
  • Macula Lutea / physiopathology*
  • Macula Lutea / surgery
  • Male
  • Middle Aged
  • Perioperative Care
  • Phacoemulsification / adverse effects*
  • Postoperative Complications*
  • Prospective Studies
  • Retinal Diseases / etiology
  • Retinal Diseases / physiopathology*
  • Retinal Diseases / surgery

Substances

  • Blood Glucose
  • Glycated Hemoglobin A