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Management after cataract surgery for patients with diabetic retinopathy: a systematic review and meta-analysis

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Abstract

Purpose

To evaluate the safety and effectiveness of various treatment modalities in patients with diabetic retinopathy (DR) who underwent cataract surgery.

Methods

A comprehensive search for randomized controlled trials (RCTs) was conducted using the PubMed, Embase, Cochrane Library, and CNKI databases up to December 22, 2021. The safety and efficacy of treatment modalities were assessed using the risk ratio (RR) to compare the progression of DR and the mean difference to evaluate the best corrected visual acuity (BCVA) and macular thickness (MT).

Results

The meta-analysis of the RCTs revealed that anti-VEGF (anti-vascular endothelial growth factor) drugs significantly reduced the progression of DR [RR: 0.37 (95%CI 0.19, 0.70), P = 0.002] and improved BCVA [mean difference = − 0.06 (− 0.12, − 0.01), P = 0.03] in patients with pre-existing DR who underwent cataract surgery. Steroid drugs also showed a significant reduction in macular thickness [mean difference = − 55.63 (− 90.73, − 20.53), I2 = 56%, P = 0.002] in DR patients two weeks after cataract surgery compared to the control group. The safety profiles of different management options did not differ significantly.

Conclusion

The present meta-analysis suggests that anti-VEGF drugs can effectively slow down the progression of diabetic retinopathy, improve BCVA, and reduce MT in DR patients who underwent cataract surgery. Steroid drugs also show promise in reducing MT. However, further studies with larger sample sizes are required to compare the efficacy and safety of different management options in a multi-center clinical setting.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH et al (2017) Global causes of blindness and distance vision impairment 1990–2020: a systematic review and meta-analysis. Lancet Glob Health 5(12):e1221–e1234

    Article  PubMed  Google Scholar 

  2. Erie JC (2014) Rising cataract surgery rates: demand and supply. Ophthalmology 121(1):2–4

    Article  PubMed  Google Scholar 

  3. Klein BE, Klein R, Moss SE (1985) Prevalence of cataracts in a population-based study of persons with diabetes mellitus. Ophthalmology 92(9):1191–1196

    Article  CAS  PubMed  Google Scholar 

  4. Vukicevic M, Gin T, Al-Qureshi S (2012) Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phaco-emulsification cataract surgery. Clin Experiment Ophthalmol 40(3):282–287

    Article  PubMed  Google Scholar 

  5. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, Yang YC (2016) Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology 123(2):316–323

    Article  PubMed  Google Scholar 

  6. Patel JI, Hykin PG, Cree IA (2006) Diabetic cataract removal: postoperative progression of maculopathy–growth factor and clinical analysis. Br J Ophthalmol 90(6):697–701

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331(22):1480–1487

    Article  CAS  PubMed  Google Scholar 

  8. Cantón A, Burgos R, Hernández C, Mateo C, Segura RM, Mesa J, Simó R (2000) Hepatocyte growth factor in vitreous and serum from patients with proliferative diabetic retinopathy. Br J Ophthalmol 84(7):732–735

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu J, Jones RE, Zhao J, Zhang J, Zhang F (2015) Influence of uncomplicated phacoemulsification on central macular thickness in diabetic patients: a meta-analysis. PLoS ONE 10(5):e0126343

    Article  PubMed  PubMed Central  Google Scholar 

  10. Samanta A, Kumar P, Machhua S, Rao GN, Pal A (2014) Incidence of cystoid macular oedema in diabetic patients after phacoemulsification and free radical link to its pathogenesis. Br J Ophthalmol 98(9):1266–1272

    Article  PubMed  Google Scholar 

  11. Sarao V, Veritti D, Maurutto E, Rassu N, Borrelli E, Loewenstein A, Sadda S, Lanzetta P (2018) Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opin Pharmacother 19(14):1551–1563

    Article  CAS  PubMed  Google Scholar 

  12. Boscia F, Giancipoli E, D’Amico Ricci G, Pinna A (2017) Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol 28(1):23–28

    Article  PubMed  Google Scholar 

  13. Egger M, Smith GD, Phillips AN (1997) Meta-analysis: principles and procedures. BMJ (Clinical research ed) 315(7121):1533–1537

    Article  CAS  PubMed  Google Scholar 

  14. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 315(7109):629–634

    Article  CAS  PubMed  Google Scholar 

  15. Cochrane handbook for systematic reviews of interventions version 6.3 [https://training.cochrane.org/handbook/current]

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chae JB, Joe SG, Yang SJ, Lee JY, Sung KR, Kim JY, Kim JG, Yoon YH (2014) Effect of combined cataract surgery and ranibizumab injection in postoperative macular edema in nonproliferative diabetic retinopathy. Retina 34(1):149–156

    Article  PubMed  Google Scholar 

  18. Cheema RA, Al-Mubarak MM, Amin YM, Cheema MA (2009) Role of combined cataract surgery and intravitreal bevacizumab injection in preventing progression of diabetic retinopathy: prospective randomized study. J Cataract Refract Surg 35(1):18–25

    Article  PubMed  Google Scholar 

  19. Endo N, Kato S, Haruyama K, Shoji M, Kitano S (2010) Efficacy of bromfenac sodium ophthalmic solution in preventing cystoid macular oedema after cataract surgery in patients with diabetes. Acta Ophthalmol 88(8):896–900

    Article  CAS  PubMed  Google Scholar 

  20. Fard MA, Yazdanei Abyane A, Malihi M (2011) Prophylactic intravitreal bevacizumab for diabetic macular edema (thickening) after cataract surgery: prospective randomized study. Eur J Ophthalmol 21(3):276–281

    Article  PubMed  Google Scholar 

  21. Gupta PC, Ram J, Kumar MP, Agarwal A, Gupta V, Singh R, Bansal R, Katoch D, Dogra MR, Gupta A (2021) Effect of sustained-release long-acting intravitreal dexamethasone implant in patients of non-proliferative diabetic retinopathy undergoing phacoemulsification: a randomized controlled trial. Indian J Ophthalmol 69(11):3263–3272

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kandasamy R, Constantinou M, Rogers SL, Sandhu SS, Wickremasinghe S, Al-Qureshi S, Lim LL (2019) Prospective randomised clinical trial of intravitreal bevacizumab versus triamcinolone in eyes with diabetic macular oedema undergoing cataract surgery: 6-month results. Br J Ophthalmol 103(12):1753–1758

    PubMed  Google Scholar 

  23. Lanzagorta-Aresti A, Palacios-Pozo E, Menezo Rozalen JL, Navea-Tejerina A (2009) Prevention of vision loss after cataract surgery in diabetic macular edema with intravitreal bevacizumab: a pilot study. Retina 29(4):530–535

    Article  PubMed  Google Scholar 

  24. Lim LL, Morrison JL, Constantinou M, Rogers S, Sandhu SS, Wickremasinghe SS, Kawasaki R, Al-Qureshi S (2016) Diabetic macular edema at the time of cataract surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery - preliminary 6 month results. Clin Experiment Ophthalmol 44(4):233–242

    Article  PubMed  Google Scholar 

  25. Pollack A, Staurenghi G, Sager D, Mukesh B, Reiser H, Singh RP (2017) Prospective randomised clinical trial to evaluate the safety and efficacy of nepafenac 0.1% treatment for the prevention of macular oedema associated with cataract surgery in patients with diabetic retinopathy. Br J Ophthalmol 101(4):423–427

    Article  PubMed  Google Scholar 

  26. Salehi A, Beni AN, Razmjoo H, Beni ZN (2012) Phacoemulcification with intravitreal bevacizumab injection in patients with cataract and coexisting diabetic retinopathy: prospective randomized study. J Ocul Pharmacol Ther Off J Assoc Ocul Pharmacol Ther 28(3):212–218

    Article  CAS  Google Scholar 

  27. Singh R, Alpern L, Jaffe GJ, Lehmann RP, Lim J, Reiser HJ, Sall K, Walters T, Sager D (2012) Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol 6:1259–1269

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Singh RP, Lehmann R, Martel J, Jong K, Pollack A, Tsorbatzoglou A, Staurenghi G, Cervantes-Coste Cervantes G, Alpern L, Modi S et al (2017) Nepafenac 0.3% after cataract surgery in patients with diabetic retinopathy: results of 2 randomized phase 3 studies. Ophthalmology 124(6):776–785

    Article  PubMed  Google Scholar 

  29. Zhang WL, Ying Shao WZ (2019) Application of triamcinolone acetonide in cataract surgery with NPDR. Int Eye Sci 19:1536–1541

    Google Scholar 

  30. Song W, Conti TF, Gans R, Conti FF, Silva FQ, Saroj N, Singh RP (2020) Prevention of macular edema in patients with diabetic retinopathy undergoing cataract surgery: the PROMISE trial. Ophthalmic Surg Lasers Imaging Retina 51(3):170–178

    Article  PubMed  Google Scholar 

  31. Pollreisz A, Schmidt-Erfurth U (2010) Diabetic cataract-pathogenesis, epidemiology and treatment. Journal of ophthalmology 2010:608751

    Article  PubMed  PubMed Central  Google Scholar 

  32. Peterson SR, Silva PA, Murtha TJ, Sun JK (2018) Cataract surgery in patients with diabetes: management strategies. Semin Ophthalmol 33(1):75–82

    Article  PubMed  Google Scholar 

  33. Laursen SB, Erichsen JH, Holm LM, Kessel L (2019) Prevention of macular edema in patients with diabetes after cataract surgery. J Cataract Refract Surg 45(6):854–869

    Article  PubMed  Google Scholar 

  34. Zhao LQ, Cheng JW (2019) A systematic review and meta-analysis of clinical outcomes of intravitreal anti-VEGF agent treatment immediately after cataract surgery for patients with diabetic retinopathy. J Ophthalmol 2019:2648267

    Article  PubMed  PubMed Central  Google Scholar 

  35. Feng Y, Zhu S, Skiadaresi E, McAlinden C, Tu R, Gao R, Stephens JW, Wang Q, Huang J (2019) Phacoemulsification cataract surgery with prophylactic intravitreal bevacizumab for patients with coexisting diabetic retinopathy: a meta-analysis. Retina 39(9):1720–1731

    Article  CAS  PubMed  Google Scholar 

  36. Ting DS, Cheung GC, Wong TY (2016) Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 44(4):260–277

    Article  PubMed  Google Scholar 

  37. Sun JK, Glassman AR, Beaulieu WT, Stockdale CR, Bressler NM, Flaxel C, Gross JG, Shami M, Jampol LM (2019) Rationale and application of the protocol S anti-vascular endothelial growth factor algorithm for proliferative diabetic retinopathy. Ophthalmology 126(1):87–95

    Article  PubMed  Google Scholar 

  38. Semeraro F, Morescalchi F, Cancarini A, Russo A, Rezzola S, Costagliola C (2019) Diabetic retinopathy, a vascular and inflammatory disease: therapeutic implications. Diabetes Metab 45(6):517–527

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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Funding

This study was supported by grants provided by the National Natural Science Foundation of China (No. 81800830).

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Authors and Affiliations

  1. Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Ophthalmic Hospital, Zhengzhou, 450052, China

    Jiahui Wu, Yongwei Zhou, Fangyuan Zhen, Shasha Wang, Qiuming Li & Shuqian Dong

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  1. Jiahui Wu
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  3. Fangyuan Zhen
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  4. Shasha Wang
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Contributions

WJH designed the research and wrote the first draft of the study. The literature search, literature selection, and data extraction were supplied by ZYW, ZFY, and DSQ. The statistical analysis, data interpretation, research quality evaluation, drafting, and critical editing of the paper were completed by WJH, ZYW, WSS, LQM, and DSQ. The study was critically evaluated by all authors, and the final draft was approved.

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Correspondence to Qiuming Li or Shuqian Dong.

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Wu, J., Zhou, Y., Zhen, F. et al. Management after cataract surgery for patients with diabetic retinopathy: a systematic review and meta-analysis. Int Ophthalmol 44, 166 (2024). https://doi.org/10.1007/s10792-024-02981-6

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