| Objective: To analyze the changes of visual acuity,central subfoveal retina and choroid thickness before and after cataract intraocular lens surgery in type 2 diabetic patients with or without diabetic retinopathy(DR),to explore the correlation between the presence and severity of DR and visual benefit and retinal status after cataract surgery,and to identify the effectiveness of early intervention of macular edema by anti-vascular endothelial growth factor(VEGF)after cataract surgery.Methods: This is a prospective study.A total of 131 patients with type 2 diabetes mellitus who were diagnosed with cataract and underwent cataract surgery in the Department of Ophthalmology of the Fourth Affiliated Hospital of China Medical University from November 2018 to May 2022 were enrolled and followed up for more than six months.Basic information,laboratory examination results,best corrected visual acuity(BCVA),central subfield thickness(CSF Thickness)and sub-foveal choroid thickness(SCT)were collected.Participants were divided into 4 groups according to the findings of fundus examination before cataract surgery: group without DR,group with mild/moderate none proliferative diabetic retinopathy(NPDR),group with severe NPDR and group with proliferative diabetic retinopathy(PDR).BCVA,CSF thickness and SCT were measured at 1 week(w),1 month(m),3 months and 6months after surgery in these groups.The correlations between the changes of BCVA and CSF thickness at follow-up visits and the severity of DR at baseline were analyzed,and the multiple linear regression equations between baseline status and BCVA and CSF thickness at 1 m and 6 m after surgery were established.All data were analyzed using SPSS 27.0 statistical software.Results: Mean BCVA of all four groups improved significantly at 1 week,1 month,3months and 6 months post cataract surgery.In the None-DR group,the mean BCVA was 46.89 ± 16.89 letters at baseline,and was 81.44 ± 6.45 letters at post-surgery week1(t = 14.60,P < 0.001).In the mild/moderate NPDR group,the mean BCVA was 49.65± 16.85 letters at baseline,and achieved the highest level at 1 month after surgery(79.42± 5.26 letters,t = 10.524,P < 0.001).In the severe NPDR group,the mean BCVA was50.00 ± 18.14 letters at baseline,and achieved the highest level at post-surgery month3(73.50 ± 5.64 letters,t = 7.150,P < 0.001).In the PDR group,the BCVA was 56.09± 15.07 letters,and the best BCVA was 73.04 ± 7.65 letters at month 3 after surgery(t= 5.513,P < 0.001).In the none-DR,mild/moderate DR,severe NPDR and PDR groups,the proportion of patients with BCVA improved by more than 3 lines was 93%,82%,70% and 70%,respectively,and the proportion of patients with BCVA decreased by more than 2 lines was 0,2%,5% and 4%,respectively.In the none-DR group,baseline CSF thickness was 211.40 ± 15.42 μm,which was significantly thickened at month 1after operation(220.53 ± 32.77 μm,t = 2.319,P = 0.025),and recovered to the preoperative level at month 6 after operation.The mean CSF thickness in the mild/moderate NPDR group was 230.40 ± 28.66 μm at baseline,and there was no significant change after surgery.The mean CSF thickness in the severe NPDR group was 247.40 ± 36.38 μm at baseline,and was significantly thickened to 252.85 ± 38.52μm at 1 week after surgery(t = 2.171,P = 0.043),and recovered to the preoperative level at month 3 after operation by intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF).In the PDR group,the CSF thickness was 246.96 ± 71.42μm at baseline,and was significantly thickened to 256.61 ± 75.47 μm at 1 week after operation(t = 2.083,P = 0.049),which recovered to the preoperative level at month 3through treatment.There were no significant changes in SCT before and after cataract surgery in all patients.Some DR patients with macular edema or abnormal CSF thickness showed optic disc staining postoperatively.There was a significant negative correlation between the severity of baseline DR and the BCVA at each post operative visit.The r values at 1 w,1 m,3 m and 6 m were-0.569,-0.628,-0.645 and-0.684,respectively(P < 0.001).There was a significant positive correlation between the severity of baseline DR and CSF thickness at each post operative visit,and the r values at 1 w,1 m,3 m,and 6 m were 0.417,0.436,0.392,and 0.431,respectively(P < 0.001).Among all the included predictive variables,the severity of baseline DR had a significant effect on the BCVA at post operation month 1;the presence of macular edema had a significant effect on the BCVA at post operation month 6;and the severity of baseline DR,the presence of macular edema,length of diabetes and glycosylated hemoglobin had a significant effect on the CSF thickness at post operation month 1.Conclusion: Phacoemulsification and intraocular lens implantation can significantly improve visual acuity in cataract patients with type 2 diabetes mellitus(with or without DR).However,the severity of preoperative DR can affect the recovery of visual acuity in the short-and medium-term after cataract surgery.The increase of macular thickness after cataract surgery is a relatively common event in DR patients,especially in patients with severe NPDR or PDR,which can be controlled through early intervention of antiVEGF intravitreous injection.Postope\rative fundus fluorescein angiography plays an important role in the identification of the type of macular edema after cataract surgery.Cataract surgery may not affect the choroidal thickness of patients with T2 DM. |
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