Poor glycemic control as a risk factor for pseudophakic cystoid macular edema in patients with diabetes

Abstract

Purpose: To specify the risk factors for pseudophakic cystoid macular edema (CME) in patients with diabetes.

Setting: Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotka, Finland.

Design: Prospective case series.

Methods: Patients with type 1 or type 2 diabetes having routine cataract surgery were evaluated. Spectral-domain optical coherence tomography imaging was performed before surgery and 1 month postoperatively.

Results: The study comprised 93 patients (95 eyes). The central retinal thickness increase was 9.7 μm ± 1.7 (SEM) in diabetic patients with no retinopathy, 22.7 ± 8.6 μm in those who had nonproliferative retinopathy, and 73.8 ± 37.4 μm in those who had proliferative retinopathy (P < .001). The central retinal thickness increase was greater in the eyes of diabetic patients with insulin dependence than in eyes of patients using noninsulin medication (21.9 ± 5.9 μm versus 8.3 ± 1.8 μm, P = .017). Serum hemoglobin A_1c concentration and inversely, patient age, were associated with central retinal thickness increase, even after adjustment for confounding factors (r = 0.607, P < .001 and r = 0.417, P = .001, respectively). The central retinal thickness change was smaller in the eyes of patients who had a nonsteroidal antiinflammatory drug (NSAID) as their postoperative antiinflammatory medication than in eyes of patients who were not prescribed NSAID medication when retinopathy was analyzed as a covariant (8.2 ± 3.6 μm versus 13.6 ± 2.9 μm, P = .016).

Conclusions: Young patient age and poor glycemic control were risk factors for postoperative central retinal thickness increase. This study showed it is necessary to identify, effectively treat, and follow-up with patients with diabetes who are at a greater risk for pseudophakic CME.