Thursday, December 27, 2012

Cataract Surgery with Diabetic Retinopathy

Question: I have a question about having cataract surgery if I have diabetic retinopathy. I have been diagnosed with diabetic retinopathy and am currently undergoing laser treatment. I am also beginning to develop a cataract and will need cataract surgery for this as well in the future. Are there any restrictions for cataract surgery if you have had laser treatment for diabetic retinopathy?

Answer: Cataract surgery and lens implants for patients with diabetic retinopathy can be performed successfully for the majority of patients but the ultimate results do depend on the overall health ad condition of the retina in terms of the progression and degree of treatment that has been rendered. First, it is critically important that a very careful and meticulous preoperative retinal evaluation confirm the level of vision that should be expected. One of the more common findings in diabetic retinopathy is the presence of Diabetic Macular Edema (DME) which can have a considerable effect of the level of best corrected vision that can be achieved-with or without cataract surgery. It is likely that your eye surgeon rendering the diabetic laser treatments is evaluating you for Diabetic Macular Edema with fluorescein angiography and ocular coherence tomography (OCT) testing. The presence of DME might actually be one of the reasons you are having diabetic laser treatment currently.
Diabetic Macular Edema is often treated with laser and/or vascular endothelial growth factor (VEGF) inhibitor injections such as Lucentis® as well as other medications. One of the concerns that many diabetics have is their susceptibility to slow or poor wound healing and infection. Modern cataract surgery is typically performed using eye drops for anesthesia rather than injections and through a very tiny self sealing incision-often between 2.2 and 3.0 mm. The precision and the architecture of this tiny incision allow it to close and heal without sutures in most cases. So, modern cataract surgery is actually quite “wound healing friendly” and requires no real modification in technique for diabetic patients. Depending on the stage of diabetic retinopathy at the time of your cataract surgery and lens implants, it is possible that your Cataract Surgeon or Retinal Specialist might place a vascular endothelial growth factor (VEGF) inhibitor injection such as Lucentis®, Eyelea® or Avastin® into the vitreous gel as a preventative and/or therapeutic measure. Assuming that you will not have had any retinal or vitreous hemorrhages prior to cataract surgery, and that the vitreous is otherwise healthy, other than these considerations and as long as any presence of macular edema has been accounted for in the setting of expectations for your ultimate vision after the cataract operation-you should have a relatively routine cataract surgery experience.  
Important Note: The information presented on the About Cataract Surgery Blog or provided in response to a request for information in the Ask Cataract Surgeons section on is not intended to diagnose or treat eye problems, eye conditions or eye diseases including appropriateness of treatment, risks, complications or side effects as related to Cataracts, Cataract Surgery or Lens Implants. In particular a response to an inquiry made on the Ask Cataract Surgeons section of is not meant to take the place of the professional medical care provided by your eye doctor, ophthalmologist and Cataract Surgeon. Contacting us via e-mail or any other means is not a substitute for medical care.

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