Incidence and Progression of Diabetic Retinopathy After Cataract Surgery: A Systematic Review and Meta-Analysis.

Autor: Lee SH; From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan., Tseng BY; From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan., Wu MC; From the School of Medicine, Tzu Chi University (S.-H.L., B.-Y.T., M.-C.W.), Hualien, Taiwan., Wang JH; Department of Medical Research, Buddhist Tzu Chi General Hospital (J.-H.W.), Hualien, Taiwan., Chiu CJ; Department of Ophthalmology and Visual Science, Tzu Chi University (C.-J.C.), Hualien, Taiwan; Department of Ophthalmology, Hualien Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation (C.-J.C.), Hualien, Taiwan. Electronic address: drcjchiu@outlook.com.tw.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Aug 22; Vol. 269, pp. 105-115. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1016/j.ajo.2024.08.017
Abstrakt: Purpose: The impact of cataract surgery on diabetic retinopathy (DR) in patients with diabetes mellitus (DM) remains uncertain. This study aimed to investigate the incidence and progression of DR in patients with DM who underwent cataract surgery.
Design: Meta-analysis.
Methods: A systematic search of PubMed, Cochrane CENTRAL, and Embase databases was conducted from inception to April 2024. Randomized controlled trials or observational cohort studies involving adult patients with DM who underwent cataract surgery were included. Studies reporting data on the incidence or progression of postoperative DR were considered. Effect sizes were determined using risk ratios (RRs) with 95% confidence intervals (CIs), and meta-analysis was performed using a random-effects model. Subgroup analysis and meta-regression were conducted on perioperative demographic factors such as types of cataract surgery, DM durations, preoperative glycated hemoglobin A1c levels, and postoperative follow-up durations.
Results: Data from 15 studies, involving 7,287 patients were analyzed. Postoperative DR incidence was elevated compared to the control group (RR, 1.38; 95% CI: 1.16-1.63; P < .001), although not significantly different in paired studies (RR, 0.85; 95% CI: 0.39-1.83; P = .671). DR progression was significantly higher after cataract surgery (RR, 1.46; 95% CI: 1.28-1.66; P < .001), irrespective of cataract surgery type and study design. Our analysis also revealed a significant increase in DR progression to sight-threatening DR, which includes clinically significant macular edema and proliferative diabetic retinopathy, following cataract surgery (RR, 1.84; 95% CI: 1.21-2.81; P = .005). Additionally, various risk factors such as preoperative HbA1c level, duration of postoperative follow-up, duration of diabetic diagnosis, age, and use of insulin therapy were investigated, However, none of these parameters significantly influenced the incidence or progression of postoperative DR.
Conclusions: Further research is needed to fully understand the incidence of DR after cataract surgery. However, our study provides moderate evidence supporting the progression of DR following such surgical interventions. Therefore, it is imperative to closely monitor DR progression within one year following cataract surgery in patients with DM.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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