Denniston Alastair K, Chakravarthy Usha, Zhu Haogang, Lee Aaron Y, Crabb David P, Tufail Adnan, Bailey Clare, Akerele Toks, Al-Husainy Sahar, Brand Christopher, Downey Louise, Fitt Alan, Khan Rehna, Kumar Vineeth, Lobo Aires, Mahmood Sajjad, Mandal Kaveri, Mckibbin Martin, Menon Geeta, Natha Salim, Ong Jong Min, Tsaloumas Marie D, Varma Atul, Wilkinson Elizabeth, Johnston Robert L, Egan Catherine A
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK.
Br J Ophthalmol. 2017 Dec;101(12):1673-1678. doi: 10.1136/bjophthalmol-2016-309838. Epub 2017 May 9.
To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two years before and after cataract surgery.
Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system.
eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy.
rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye.
4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01).
This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.
评估白内障手术前后两年内需要治疗的糖尿病性黄斑水肿（DMO）在眼部的发生率。
一项多中心全国糖尿病视网膜病变（DR）数据库研究，从电子病历系统中提取19个中心的匿名数据。
糖尿病患者中接受白内障手术且在研究开始前无DMO病史的眼睛。最小数据集包括：年龄、视力（所有时间点）、注射次数、白内障手术时间以及视网膜病变和黄斑病变的ETDRS分级。
同一眼发生首次需要治疗的DMO的发生率与白内障手术时间的关系。
4850只眼睛符合纳入标准。该队列中需要治疗的DMO发生率在手术前一年为2.9%，而在手术后一年为5.3%（p<0.01）。“需要治疗的DMO ”的风险在手术后急剧增加，在3至6个月期间达到峰值（术后0至3、3至6、6至9和9至12个月时间段的年化率分别为5.2%、6.8%、5.6%和4.0%）。风险与术前视网膜病变分级相关：术后第一年DMO的风险分别为1.0%（术前无DR）、5.4%（轻度非增殖性糖尿病视网膜病变；NPDR）、10.0%（中度NPDR）、13.1%（重度NPDR）和4.9%（PDR）（p<0.01）。
这项大型的真实世界研究表明，对于所有等级的视网膜病变，白内障手术后一年内需要治疗的DMO发生率急剧增加，在术后3至6个月达到峰值。中度和重度NPDR患者的风险尤其高。
