Don’t Rush to Treat Diabetic Macular Edema Post-Phaco
April 2, 2009
A recent article describes the natural history of diabetic retinopathy after phaco. As we would expect, the edema worsened in many diabetic patients, but interestingly, a pretty high percentage returned to baseline after three months. So it may be reasonable to wait three months before treating. I often inject Kenalog prophylactically at the end of the phaco if the macula looks like it’s going to get worse after surgery. Maybe that’s a little aggressive. I wonder how others deal with this issue.
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One Response to “Don’t Rush to Treat Diabetic Macular Edema Post-Phaco”
This was a helpful article. In the mid-1990’s we were all cautioned against phaco if there was treatable macular edema. Cataract surgery would worsen macular edema after cataract surgery.
In theory, there are probably two types of macular edema in the post-cataract diabetic retinopathy patient; diabetic macular edema and cystoid macular edema. I believe that the cystoid macular edema component is the one that is transient. This study may simply be confirming this, but we don’t have any true way to measure or prove this (believe it or not).
This article indicates that phaco is safer than we once thought in the diabetic population. I do not think we were wrong, but may be a result of better phaco technique, less imflammation and quicker operating times.
Oh yes, back to the point. In our area, we use less intraoperative Kenalog and still try to gain control of the macular edema pre-op. It seems to highlight to the patient that there are several factors causing the decreased vision.
Randall V. Wong, M.D.
Retina Specialist
http://www.TotalRetina.com
