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      Second Eye Cataract Surgery in the Diabetes Patient? Quality of Life Gains and Speed of Visual and Functional Rehabilitation

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          Abstract

          Purpose: To assess gains in quality of life (QOL) and visual acuity (VA), and to evaluate speed of visual and functional rehabilitation in diabetes patients with different stages of retinopathy (DR) after phacoemulsification in either one or both eyes. Methods: This prospective longitudinal study comprised 102 patients having either (1) first eye, or (2) first and subsequent second eye cataract surgery. One surgeon performed all surgeries. In both groups, the following subset of patients was compared: those with no apparent retinopathy (no DR), those with mild nonproliferative DR (NPDR), those with severe NPDR, and those with proliferative DR. VA and questionnaire (VF-14) responses were recorded prior to and 1, 3, 6, 8 and 12 months after surgery. Results: Patients with no DR and mild NPDR showed a significantly more rapid speed of visual and functional rehabilitation compared to patients with severe NPDR and proliferative DR. Maximum visual and functional results for these patients were observed 1 month after surgery, and values were significantly higher in comparison to other patients (p values <0.0001). Patients with no DR and mild NPDR who had second eye surgery demonstrated significant improvements (VA, QOL) and sustainment of the improved functional status achieved after first eye surgery (p < 0.001). Conclusions: Patients with no DR and mild NPDR show greater significant improvements in QOL and VA, and a more rapid speed of visual and functional rehabilitation in comparison to patients with more advanced DR. Functional gains are sustained at 1 year after surgery, if second eye surgery is performed.

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          Most cited references10

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          Impact of cataract surgery on health-related quality of life in nursing home residents.

          To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. A prospective cohort study enrolled 30 nursing home residents (>or=60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p<0.001). Adjusting for age differences in the two groups, the cataract surgery group exhibited significant score improvement in the general vision (p = 0.005), reading (p = 0.001), psychological distress (p = 0.015), and social interaction (p = 0.033) subscales of the Nursing Home Vision-targeted Health-Related Quality of Life Questionnaire and the VF-14 (p = 0.004). There were no group differences in the SF-36, Geriatric Depression Scale or the Cataract Symptom Score. Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision.
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            Cystoid macular oedema following cataract extraction in patients with diabetes.

            The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.
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              Visual outcome after phacoemulsification and IOL implantation in diabetic patients.

              To follow visual acuity (VA) and progression of diabetic retinopathy (DR) after phacoemulsification in diabetic patients with different stages of DR and controls. This prospective study included 27 diabetic patients with no or mild to moderate non-proliferative DR; 25 patients with moderate to severe non-proliferative, or proliferative DR; and 22 non-diabetic controls. All patients underwent uncomplicated, phacoemulsification surgery, with implantation of a heparin-surface modified (HSM) poly(methylmethacrylate) (PMMA) intraocular lens (IOL) into the capsular bag. Colour fundus photographs and fluorescein angiograms (FA) were taken at 1 week (baseline), 3 months, and 1 year postoperatively to determine stability or progression of DR. The VA of 46 diabetic eyes (88%), was improved 1 year after surgery and only six eyes (12%) were unchanged or worse. 41 diabetic eyes (79%) achieved a VA of 0.5 or better and 11 eyes (21%) had a final VA lower than 0.5. Significantly lower final corrected VA was found 1 year after surgery in eyes with advanced DR (median 0.5; range 0.1-1.0) compared with controls (1.0; 0.1-1.0) and eyes with no or mild to moderate DR (1.0; 0.1-1.0). Eyes with mild to moderate DR and clinically significant macular oedema (CSMO) 1 week postoperatively had a lower final VA than those without CSMO. Angiographic cystoid macular oedema (CMO) was detected with FA in 15% of all diabetic eyes 1 week postoperatively. 41 eyes (79%) showed no change or improvement of the retinal status 1 year after cataract surgery. Progression was found in 11 eyes (21%), mainly in eyes with mild to moderate DR and moderate to severe DR. Eyes with an indication for laser photocoagulation at baseline showed a significantly higher rate of progression of DR after surgery than those without indication for laser treatment. The final visual outcome was improved in the majority of diabetic eyes. Eyes with CSMO at the time of surgery had the worst prognosis regarding postoperative VA.
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                Author and article information

                Journal
                ORE
                Ophthalmic Res
                10.1159/issn.0030-3747
                Ophthalmic Research
                S. Karger AG
                0030-3747
                1423-0259
                2009
                December 2008
                13 October 2008
                : 41
                : 1
                : 2-8
                Affiliations
                aDepartment of Ophthalmology, and bCore Unit for Medical Statistics and Informatics, Medical University of Vienna, Vienna, cDepartment of Ophthalmology, Medical University of Graz, Graz, Austria
                Article
                162110 Ophthalmic Res 2009;41:2–8
                10.1159/000162110
                18849635
                307a281d-dae9-4219-80f2-8694ab679971
                © 2008 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 07 June 2006
                : 16 August 2007
                Page count
                Figures: 4, Tables: 3, References: 27, Pages: 7
                Categories
                Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Phacoemulsification,Cataract,Diabetes
                Vision sciences, Ophthalmology & Optometry, Pathology
                Phacoemulsification, Cataract, Diabetes

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