In patients with diabetic retinopathy, cataract extraction is frequently followed by a fast worsening of retinal conditions, there are comments, suggestions on how reduce this phenomenon or to prevent severe retinal damage?
I use routinely Bromfenac drops but in my experience even in well controlled Diabetic Patients (whit Hba1c
What you do if the patient develop pseudo Phakic DME? Macular grid, Anti VEGF, or both. Which Anti VEGF do you recommend for a patient of a developing country lucentin or avastin? What is rationale of doing 3 monthly FA if the patient VA remains normal and macula n retina remains dry?
sometimes use of steroids implant may be helpful in preventing neovascular proliferation and hemorrages especially in young patients so in more severe cases I use to combine both techniquest starting from ozurdex followed after one or two weeks by cataract extraction.
Your opinion about raised IOP& steroid implant? Do you have any study& What percentage of this group required Trab or other anti glaucoma measures?
If you control the diabetes or diabetic eye disease preoperatively there is little evidence of excess progression of retinopathy / maculopathy. If there has been inadequate preoperative control then there is an increased risk of progression of all forms of retinopathy. Personally, after phacoemulsification surgery, I give postoperative steroids and non-steroidal anti-inflammatory drops and perhaps more importantly I follow them up in my secondary care clinic rather than transfer them to a primary care provider.
In our practice, during the preoperative examination for cataract surgery, PRP is advised to be performed if the fundus changes are severe. One month after cataract surgery, dilated fundus examination should be performed and proper follow up and screening will be arranged. Last but not the least, the patient should maintain a stable and controlled blood sugar level by an endocrinologist.
In diabetes patients in pre-op will be good to prescribe Doxium ( Calcii dobesilatis) 500 mg once a day during a meal 20-30 days preop. In ME pre-op add also AZOPT 1% twice, Acular 3 times 3 days preop ( Bromfenac is unavailable ), VigaDexa ( Alcon)qd 3 days, at the day of operation 2 times, at the end of operation also, and continue postoperatively 1mo qd together with Diclophenac 0.1% qd 1mo
Postoperatively I prescribe also Voltaren oral during 2 weeks. I agree with close monitoring in post-op - each 1 or 2 weeks during 1.5 mo personally by surgeon instead of promary care. It goes without saying sugar control HbA1c level depending on severity
of preexisting DR -in NPDR 6.5-less than 7.0%, in PDR less than 7.5% and blood pressure control medically 140 systoloic and 80 mm Hg diastolic.
I also ask my patient to keep blood lipid profile with in normal level and monitor renal function.If the patient is pregnant more frequent retinal exam is req tosee development or progression of existing retinopathy.
We can not add much but usually most of us avoid surgery to diabetic patients unless the control is good, the surgery necessary for treating significant diabetic retinopathy and for the patient visual needs.