Eyeworld

MARCH 2021 | EYEWORLD | 57 C References 1. Romero-Aroca P, et al. Nonpro- liferative diabetic retinopathy and macular edema progression after phacoemulsification: pro- spective study. J Cataract Refract Surg. 2006;32:1438–1444. 2. Pollack A, et al. Progression of diabetic retinopathy after cata- ract extraction. Br J Ophthalmol. 1991;75:547–551. 3. Siddiqui MZ, et al. Visual outcomes and intraoperative complications of cataract surgery in nAMD: A multicenter database study. Poster presen- tation at the 2020 American Academy of Ophthalmology Virtual Congress. Relevant disclosures Charles: None Devgan: None Weng: None have us perform the cataract surgery first, and they may also premedicate with an intravitreal injection first." Dr. Charles also stressed that cataract surgery does not make DME worse, noting that he thinks inflammatory CME was likely misin- terpreted as DME using OCT thickness data in studies that suggest that cataract surgery does increase DME. He also said that OCT is neces- sary before every cataract surgery. Cataract surgery in dry AMD and wet AMD When choosing an IOL for patients with AMD, Dr. Charles said not to use multifocal or EDOF IOLs. Multifocal IOLs can decrease contrast sensitivity and generally should be avoided in patients with macular disease, he said. In terms of considerations for timing of the surgery with intravitreal injections, Dr. Charles said not to alter the injection cycle or interval. Cataract surgery must be performed in the mid- dle of the injection interval (not the same day or immediately pre- or postop), he said. Dr. Weng added that if a patient had a recent retinal detachment, she prefers to wait at least 3 months before proceeding with surgery. In patients with a prior PVD, she will not necessarily bring them in for a preop evaluation if the PVD occurred in the remote past and there are no other risk factors; if the PVD occurred recently, however, she does like to perform a scleral-depressed examination preoperatively. Cataract surgery in diabetics Dr. Weng said historically, there was a concern that inflammation from cataract surgery could induce cytokine release and breakdown of the blood-retinal barrier that could theoretically worsen diabetic macular edema (DME). The literature is mixed when it comes to the possi- bility of cataract surgery inducing DME, 1,2 but this association is less apparent in more recent studies that employ modern phacoemulsification techniques and technology, Dr. Weng said. "Remember that it can also be difficult to discern whether postoperative macular edema is truly an exacerbation of DME versus Irvine-Gass syndrome; a fluorescein angiogram can be help- ful in these situations," she said. Additionally, Dr. Weng said that if a patient has no history of DME, she does not specifically ask to see these patients preoperatively (as- suming that an OCT has been obtained by the cataract surgeon) or postoperatively unless they are experiencing visual symptoms. However, in patients with a recent history of or active DME, she likes to see them in the perioperative period to ensure that their retinal status is optimized before they go to the OR and that they do not require retinal treatment afterward. She recom- mends obtaining an OCT for all patients prior to cataract surgery. According to Dr. Devgan, patients who have their diabetes under control and who have minimal background diabetic retinopathy without macular lesions tend to do very well with cataract surgery. "However, patients who have significant diabetic retinal disease, such as macular edema or proliferative vasculopathy, should be treated by a retinal colleague prior to cataract surgery," he said. "If the patient has a cataract that is bad enough to impair visual- ization of the retina, our retinal colleagues will continued on page 58 A 75-year-old patient developed a posterior vitreous detachment 3 weeks after uncomplicated cataract surgery in his right eye. Source: Christina Weng, MD, MBA

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