Paducah Retinal Center, Paducah, KY, USA.
JAMA Ophthalmol. 2013 Jul;131(7):870-9. doi: 10.1001/jamaophthalmol.2013.2313.
The incidence of development or worsening of macular edema (ME) is variable in eyes without diabetic ME (DME) undergoing cataract surgery.
To estimate the incidence of central-involved ME 16 weeks following cataract surgery in eyes with diabetic retinopathy without definite central-involved DME preoperatively.
DESIGN, SETTING, AND PARTICIPANTS: In a multicenter, prospective, observational study, 293 participants with diabetic retinopathy without definite central subfield thickening on optical coherence tomography (OCT) underwent cataract surgery.
Cataract extraction surgery performed within 28 days of enrollment of eyes without DME in individuals with diabetes mellitus.
Development of central-involved ME defined as the following: (1) OCT central subfield thickness of 250 μm or greater (time-domain OCT) or 310 μm or greater (spectral-domain OCT) with at least a 1-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; (2) at least a 2-step increase in logOCT central subfield thickness preoperatively to the 16-week visit; or (3) nontopical treatment for ME received before the 16-week visit with either of the OCT criteria met at the time of treatment.
The median participant age was 65 years. The median visual acuity letter score was 69 letters (Snellen equivalent 20/40). Forty-four percent of eyes had a history of treatment for DME. Sixteen weeks postoperatively, central-involved ME was noted in 0% (95% CI, 0%-20%) of 17 eyes with no preoperative DME. Of eyes with non-central-involved DME, 10% (95% CI, 5%-18%) of 97 eyes without central-involved DME and 12% (95% CI, 7%-19%) of 147 eyes with possible central-involved DME at baseline progressed to central-involved ME. History of DME treatment was significantly associated with central-involved ME development (P < .001).
In eyes with diabetic retinopathy without concurrent central-involved DME, presence of non-central-involved DME immediately prior to cataract surgery or history of DME treatment may increase the risk of developing central-involved ME 16 weeks after cataract extraction.
在接受白内障手术的无糖尿病性黄斑水肿（DME）的眼中，黄斑水肿（ME）的发生或恶化的发生率是可变的。
评估术前无明确中心受累 DME 的糖尿病性视网膜病变患者在白内障手术后 16 周时中央受累 ME 的发生率。
设计、地点和参与者：在一项多中心、前瞻性、观察性研究中，293 名患有糖尿病性视网膜病变且光学相干断层扫描（OCT）无明确中心区增厚的患者接受了白内障手术。
在无 DME 的个体的白内障手术在入组后 28 天内进行。
定义为以下情况的中央受累 ME 的发展：（1）OCT 中央区厚度为 250μm 或更大（时域 OCT）或 310μm 或更大（频域 OCT），术前至 16 周就诊时至少有 1 步增加的 logOCT 中央区厚度；（2）术前至 16 周就诊时至少增加 2 步 logOCT 中央区厚度；或（3）在 16 周就诊前因 ME 接受非局部治疗，且在治疗时符合其中任何一项 OCT 标准。
中位参与者年龄为 65 岁。中位视力字母评分 69 个字母（Snellen 等价物 20/40）。44%的眼有 DME 的治疗史。术后 16 周，17 只术前无 DME 的眼中有 0%（95%CI，0%-20%）出现中央受累 ME。在无中央受累 DME 的 97 只眼中和基线时有可能中央受累 DME 的 147 只眼中，10%（95%CI，5%-18%）和 12%（95%CI，7%-19%）分别进展为中央受累 ME。DME 治疗史与中央受累 ME 的发展显著相关（P<.001）。
在无同时存在的中央受累 DME 的糖尿病性视网膜病变眼中，白内障手术前存在非中央受累 DME 或 DME 治疗史可能会增加白内障摘除术后 16 周发生中央受累 ME 的风险。
