Denier C, Fajnkuchen F, Giocanti-Aurégan A
Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France.
Ophthalmology department, Avicenne hospital, DHU vision and handicaps, 125, rue de Stalingrad, 93000 Bobigny, France; Centre d'imagerie et de Laser, 11, rue Antoine-Bourdelle, 75015 Paris, France.
J Fr Ophtalmol. 2018 Dec;41(10):904-909. doi: 10.1016/j.jfo.2018.03.025. Epub 2018 Nov 22.
To assess in a real life setting the progression of central retinal thickness (CRT) during the first month after surgery in diabetic patients without previous diabetic macular edema (DME) and to identify potential risk factors for DME leading to increased postoperative follow-up.
We conducted a prospective study of diabetic patients without history of DME who underwent uncomplicated cataract surgery. Best-corrected visual acuity (BCVA) and SD-OCT were performed 7 days and 1 month after surgery. We assumed absence of preoperative DME when there was no edema of SD-OCT at D7. Our primary endpoint was the central retinal thickness (CRT) variation between 7 days and 1 month after cataract surgery in patients without previous history of DME.
We included 55 eyes of 42 patients. BCVA was 0.57±0.72 logMar (20/80) prior to surgery and increased significantly to 0.11±0.17 (20/25) at one month (P=0.001) post-surgery. The mean baseline CRT was 209±35μm and 229±69μm (P=0.06) one month after surgery. Four eyes (7.4%) developed macular edema at one month. We found no linear correlation between HbA1C and CRT.
DISCUSSION/CONCLUSION: We found no link between a high level of HbA1C and postoperative increase in CRT. We found that cataract surgery in diabetic patients without previous DME has no negative impact on CRT, and visual outcomes are good. We suggest that in diabetic patients without complete visual recovery at 1-month post-cataract surgery, OCT examination should be performed in order to detect an early stage of DME.
在现实生活环境中评估无糖尿病性黄斑水肿（DME）病史的糖尿病患者术后第一个月中心视网膜厚度（CRT）的进展情况，并确定导致术后随访增加的DME潜在危险因素。
我们对无DME病史且接受了无并发症白内障手术的糖尿病患者进行了一项前瞻性研究。在术后7天和1个月时进行最佳矫正视力（BCVA）和SD-OCT检查。当术后第7天SD-OCT无水肿时，我们假定术前无DME。我们的主要终点是无DME病史患者白内障手术后7天至1个月之间的中心视网膜厚度（CRT）变化。
我们纳入了42例患者的55只眼。术前BCVA为0.57±0.72 logMar（20/80），术后1个月显著提高至0.11±0.17（20/25）（P = 0.001）。术后1个月时平均基线CRT为209±35μm，术后1个月时为229±69μm（P = 0.06）。4只眼（7.4%）在1个月时出现黄斑水肿。我们发现糖化血红蛋白（HbA1C）与CRT之间无线性相关性。
讨论/结论：我们发现HbA1C水平高与术后CRT增加之间无关联。我们发现，无DME病史的糖尿病患者进行白内障手术对CRT无负面影响，视觉效果良好。我们建议，在白内障手术后1个月视力未完全恢复的糖尿病患者中，应进行OCT检查以检测DME的早期阶段。
