Cataract surgery in diabetic retinopathy

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Summary of Evidence

Post-operative diabetic retinopathy progression

Intravitreal Triamcinolone vs Intravitreal Bevacizumab

Intravitreal bevacizumab and triamcinolone acetonide had decreased progression of diabetic retinopathy compared to previous studies where no adjunctive treatment was administered.(DiMECat, 2020). {Sasongko MB, Rogers S, Constantinou M, Sandhu SS, Wickremasinghe SS, Al-Qureshi S, Lim LL. Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial. Clin Exp Ophthalmol. 2020 Aug;48(6):793-801.}

Post-operative macular thickness

Subconjunctival Triamcinolone vs Intravitreal Bevacizumab

Diabetic patients who received subconjunctival triamcinolone at the end of cataract surgery had a lower macular thickness and volume at six and 12 weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.(PREMED, 2018). {Wielders LHP, Schouten JSAG, Winkens B, van den Biggelaar FJHM, Veldhuizen CA, Murta JCN, Goslings WRO, Kohnen T, Tassignon MJ, Joosse MV, Henry YP, Nagy ZZ, Rulo AHF, Findl O, Amon M, Nuijts RMMA; ESCRS PREMED study group. Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. J Cataract Refract Surg. 2018 Jul;44(7):836-847.}

Evidence

1. Background

2. Steroids

2.1 Intravitreal Triamcinolone

2.1.1 Intravitreal Triamcinolone vs Intravitreal Bevacizumab

Clinical Trial

2020 Sasongko et.al. (DiMECAT)

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2020
Clinical Trial

Intravitreal bevacizumab and triamcinolone acetonide had decreased progression of diabetic retinopathy compared to previous studies where no adjunctive treatment was administered. {Sasongko MB, Rogers S, Constantinou M, Sandhu SS, Wickremasinghe SS, Al-Qureshi S, Lim LL. Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial. Clin Exp Ophthalmol. 2020 Aug;48(6):793-801.}

  • Randomized controlled trial of intravitreal triamcinolone vs intravitreal bevacizumab in cataract surgery (61 patients)
  • Findings (6-months):
    • Intravitreal bevacizumab and triamcinolone acetonide had decreased progression of diabetic retinopathy compared to previous studies where no adjunctive treatment was administered.
cited by count

2.2 Subconjunctival Triamcinolone

2.2.1 Subconjunctival Triamcinolone vs Intravitreal Bevacizumab

Clinical Trial

2018 Wielders et.al. (PREMED)

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2018
Clinical Trial

Diabetic patients who received subconjunctival triamcinolone at the end of cataract surgery had a lower macular thickness and volume at six and 12 weeks postoperatively than patients who did not. Intravitreal bevacizumab had no significant effect.{Wielders LHP, Schouten JSAG, Winkens B, van den Biggelaar FJHM, Veldhuizen CA, Murta JCN, Goslings WRO, Kohnen T, Tassignon MJ, Joosse MV, Henry YP, Nagy ZZ, Rulo AHF, Findl O, Amon M, Nuijts RMMA; ESCRS PREMED study group. Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. J Cataract Refract Surg. 2018 Jul;44(7):836-847.}

  • Randomized controlled trial of subconjunctival triamcinolone vs intravitreal bevacizumab vs both treatments vs no additional treatment in cataract surgery (213 patients)
  • Findings (3-months):
    • Patients who received subconjunctival triamcinolone had signficantly decreased macular thickness than those who did not.
    • No patient who received subconjunctival triamcinolone acetonide developed cystoid macular oedema.
    • Intravitreal bevacizumab had no significant effect on macular thickness.
cited by count

3. Anti-VEGF intravitreal injection

3.1 Bevacizumab

3.1.1 Intravitreal Bevacizumab vs Intravitreal Triamcinolone

Refer above 2.1.1

3.1.2 Intravitreal Bevacizumab vs Subconjunctival Triamcinolone

Refer above 2.2.1

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