Purpose of review: Recent studies have focused on interventions to minimize progression of retinal disease in diabetic patients undergoing cataract surgery. Here, we review the evidence for progression of diabetic retinal disease with cataract surgery and critically analyze the interventions proposed to minimize it.
Recent findings: Peri-operative intravitreal bevacizumab, sub-Tenon's triamcinolone, and panretinal photocoagulation (PRP) after cataract surgery (instead of before) have been examined as ways to improve cataract surgery results in diabetic patients. The bevacizumab and triamcinolone results are promising, but the inclusion criteria are variable, the sample sizes are small, and the follow-up is short. Postsurgery PRP shows improved cataract surgery results in diabetics with more severe retinopathy up to 1 year after surgery.
Summary: Recent studies do not support the generalized conclusion that phacoemulsification surgery causes progression of retinopathy and macular edema in all diabetic patients. In certain populations of diabetic patients undergoing cataract surgery, peri-operative triamcinolone and bevacizumab may blunt the progression of diabetic macular edema and diabetic retinopathy. The optimal timing of PRP in relation to cataract surgery in patients with more severe retinopathy warrants further evaluation.