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Optimizing treatment for diabetic macular edema during cataract surgery

Diabetic macular edema (DME) causes visual impairment in diabetic retinopathy (DR). Diabetes mellitus is a global epidemic and diabetic individuals are at risk of developing DR. Approximately 1 in 10 diabetic patients suffers from DME, which is the commonest cause of vision-threatening DR at primary...

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Autores principales: Chan, Leo Ka Yu, Lin, Sui Sum, Chan, Fiona, Ng, Danny Siu-Chun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905225/
https://www.ncbi.nlm.nih.gov/pubmed/36761187
http://dx.doi.org/10.3389/fendo.2023.1106706
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author Chan, Leo Ka Yu
Lin, Sui Sum
Chan, Fiona
Ng, Danny Siu-Chun
author_facet Chan, Leo Ka Yu
Lin, Sui Sum
Chan, Fiona
Ng, Danny Siu-Chun
author_sort Chan, Leo Ka Yu
collection PubMed
description Diabetic macular edema (DME) causes visual impairment in diabetic retinopathy (DR). Diabetes mellitus is a global epidemic and diabetic individuals are at risk of developing DR. Approximately 1 in 10 diabetic patients suffers from DME, which is the commonest cause of vision-threatening DR at primary-care screening. Furthermore, diabetes predisposes to a higher frequency and a younger onset of cataract, which further threatens vision in DME patients. Although cataract extraction is an effective cure, vision may still deteriorate following cataract surgery due to DME progression or recurrence, of which the risks are significantly higher than for patients without concurrent or previous history of DME at the time of operation. The management of pre-existing DME with visually significant cataract is a clinical conundrum. Deferring cataract surgery until DME is adequately treated is not ideal because of prolonged visual impairment and maturation of cataract jeopardizing surgical safety and monitoring of DR. On the other hand, the progression or recurrence of DME following prompt cataract surgery is a profound disappointment for patients and ophthalmic surgeons who had high expectations for postoperative visual improvement. Prescription of perioperative anti-inflammatory eye drops is effective in lowering the risk of new-onset DME after cataract surgery. However, management of concurrent DME at the time of cataract surgery is much more challenging because DME is unlikely to resolve spontaneously even with the aid of anti-inflammatory non-steroidal or steroid eye drops. A number of clinical trials using intravitreal injection of corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) as first-line therapy have demonstrated safety and efficacy to treat DME. These drugs have also been administered perioperatively for the prevention of DME worsening in patients undergoing cataract surgery. This article reviews the scientific evidence to guide ophthalmologists on the efficacy and safety of various therapies for managing patients with DME who are particularly vulnerable to cataract surgery-induced inflammation, which disintegrates the blood–retinal barrier and egression of fluid in macular edema.
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spelling pubmed-99052252023-02-08 Optimizing treatment for diabetic macular edema during cataract surgery Chan, Leo Ka Yu Lin, Sui Sum Chan, Fiona Ng, Danny Siu-Chun Front Endocrinol (Lausanne) Endocrinology Diabetic macular edema (DME) causes visual impairment in diabetic retinopathy (DR). Diabetes mellitus is a global epidemic and diabetic individuals are at risk of developing DR. Approximately 1 in 10 diabetic patients suffers from DME, which is the commonest cause of vision-threatening DR at primary-care screening. Furthermore, diabetes predisposes to a higher frequency and a younger onset of cataract, which further threatens vision in DME patients. Although cataract extraction is an effective cure, vision may still deteriorate following cataract surgery due to DME progression or recurrence, of which the risks are significantly higher than for patients without concurrent or previous history of DME at the time of operation. The management of pre-existing DME with visually significant cataract is a clinical conundrum. Deferring cataract surgery until DME is adequately treated is not ideal because of prolonged visual impairment and maturation of cataract jeopardizing surgical safety and monitoring of DR. On the other hand, the progression or recurrence of DME following prompt cataract surgery is a profound disappointment for patients and ophthalmic surgeons who had high expectations for postoperative visual improvement. Prescription of perioperative anti-inflammatory eye drops is effective in lowering the risk of new-onset DME after cataract surgery. However, management of concurrent DME at the time of cataract surgery is much more challenging because DME is unlikely to resolve spontaneously even with the aid of anti-inflammatory non-steroidal or steroid eye drops. A number of clinical trials using intravitreal injection of corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) as first-line therapy have demonstrated safety and efficacy to treat DME. These drugs have also been administered perioperatively for the prevention of DME worsening in patients undergoing cataract surgery. This article reviews the scientific evidence to guide ophthalmologists on the efficacy and safety of various therapies for managing patients with DME who are particularly vulnerable to cataract surgery-induced inflammation, which disintegrates the blood–retinal barrier and egression of fluid in macular edema. Frontiers Media S.A. 2023-01-25 /pmc/articles/PMC9905225/ /pubmed/36761187 http://dx.doi.org/10.3389/fendo.2023.1106706 Text en Copyright © 2023 Chan, Lin, Chan and Ng https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Chan, Leo Ka Yu
Lin, Sui Sum
Chan, Fiona
Ng, Danny Siu-Chun
Optimizing treatment for diabetic macular edema during cataract surgery
title Optimizing treatment for diabetic macular edema during cataract surgery
title_full Optimizing treatment for diabetic macular edema during cataract surgery
title_fullStr Optimizing treatment for diabetic macular edema during cataract surgery
title_full_unstemmed Optimizing treatment for diabetic macular edema during cataract surgery
title_short Optimizing treatment for diabetic macular edema during cataract surgery
title_sort optimizing treatment for diabetic macular edema during cataract surgery
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905225/
https://www.ncbi.nlm.nih.gov/pubmed/36761187
http://dx.doi.org/10.3389/fendo.2023.1106706
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