SCIENTIFIC POSTER 2016_Macular Changes After Uneventful Phaco in Diabetic Patients and Risk Factors Contributing to Increase Retina Thickness Maaly Abdel Fattah

Introduction:

The incidence of subclinical macular edema after uneventful phacoemulsification has become an issue of safety for this frequently performed operation. Advances in phacoemulsification techniques and intraocular lens design have led to improved outcomes following cataract surgery. Nevertheless, ME may develop and can result in suboptimal postoperative vision.

Aim of the study:

The aim of our study was to evaluate the subclinical influence of uncomplicated phacoemulsification surgery on foveal thickness in the early postoperative period and to assess contributing risk factors in a tertiary hospital.

Materials and Methods:

This study was conducted on 50 eyes of 44 subjects who underwent uneventful phacoemulsification and posterior chamber IOL implantation in King Faisal Specialist Hospital and Research center. They were divided into 2 groups:
Group 1: Diabetes mellitus group consisted of 25 eyes (21 diabetic patients),
Group 2: Control group consisted of 25 eyes (23 non-diabetic patients).
BCVA and OCT were recorded preoperatively, 2 weeks, one month and two months postoperative.

Results:

Despite that macular foveal thickness (MFT) was stable 2 weeks, 1 month and 2 months postoperative in the control group; our study showed significant increase in macular foveal thickness (MFT) 1 month and 2 months post-operative in diabetic group compared to the 2nd week postoperative. MFT in diabetic patients was higher than control group preoperative and postoperative (2 weeks, 1 month, and 2 months) with high statistical significance difference. Logarithmic transformation of retinal thickness is a proposed method for assessing whether the observed OCT change in a patient is real; one step log scale change exceeds the measurement error for all degrees of retinal thickness in current instruments. This Logarithmic transformation of retinal thickness has a value for the follow up visits for statistical comparions. It is calculated by taking the log base of the ratio of the central subfield thickness divided by 200 and rounding to the nearest hundredth. Our results showed that after converting the MFT into Log OCT, the MFT in diabetic and control groups was stable postoperatively without any step deterioration.
In Diabetic group: MFT of 64%, 68%, and 60 % of eyes were stable in 2nd week, 1st month & 2nd month postoperative respectively. 5 eyes (20%) showed one step deterioration in the second month postoperative. only one eye showed 3 step deterioration in the 1st month and 2nd month postoperative.
In control group: MFT of 84%, 76%, and 80 % of eyes were stable in 2nd week, 1st month & 2nd month postoperative respectively. 3 eyes (12%) showed only one step deterioration in the first month postoperative. No one showed deterioration 2 or 3 steps in the 1st month or 2nd month postoperative. Visual acuity is markedly improved from 0.6 to 0.2 postoperatively in all patients of group 1 and 2 at the second week postoperative. Despite there was no statistically significant difference in the VA recorded in diabetic patients at 2nd week, 1st month and 2nd month postoperative, statistical significance difference was noted in group 2 as the visual acuity improved to 0.2 in the 2nd week then showed one line improvement in the 1st month and 2nd month postoperative. There was no statistically significant difference in the VA (log MAR) between both diabetic patients and control group either in the 2nd week, 1st or 2nd week postoperative. In the diabetic group 19 (76%), 20 (80%), 22 (88%) eyes showed improvement of their vision at 2nd week, 1st month and 2nd month postoperative respectively. While in the control group most of eyes showed improvement over the follow up period with no one showed deterioration of his vision. There was no statistical significance correlation between BCVA (log MAR) and mean foveal thickness in both groups except at the second month in diabetic patients where the BCVA correlated significantly with MFT. Preoperative and postoperative Visual acuity has no statistical significance correlation with Age and DM duration. The MFT in patients having elevated glycosylated hemoglobin (Hac1) is high compared to diabetic patients having normal Hac1 with a highly statistical significance difference in 1 month and 2 month postoperative. The visual acuity 2 weeks postoperatively improved significantly in diabetic patients with normal Hac1 reaching 20/20 compared to patients with high Hac1 The mean preoperative OCT is high in hypertensive diabetic patients compared to hypertensive patients in the control group. There was no statistical significance between hypertensive and normotensive patients in visual acuity and OCT thickness in control group Despite diabetic hypertensive patients showed strong correlation in VA postoperatively being highly significant at 1st month, their MFT was only significant at 1st month postoperatively. Diabetic patients with renal failure showed statistically significant correlation in VA 2 weeks, 1 month and 2 months postoperatively compared to diabetic patients without renal failure, with no statistical significance in the MFT. Diabetic patients with hyperlipidemia showed statistical significant correlation in OCT thickness 2 weeks and 1 month postoperatively compared to diabetic patients without hyperlipidemia. Despite the low MFT in diabetic patients with heart failure but it showed statistically significant correlation in OCT thickness after 1 month and 2 months postoperatively compared to diabetic one without heart failure. In the control group, none of our patients had heart failure. Mean MFT preoperatively, 2 weeks, 1 month and 2 months postoperatively in diabetic patients with diabetic retinopathy (mild, moderate and involuted DR) was statistically higher compared to patients without DR. There were statistical improvement of visual acuity after 1 and 2 month postoperatively in patients with no DR than those with DR.

Conclusion:

Log OCT MFT in diabetic and control groups was stable postoperatively without any step deterioration. Visual acuity is markedly improved from 0.6 to 0.2 postoperatively in all patients of group 1 and 2 at the second week postoperative. The presence of diabetic retinopathy (DR) or the high level of Hac1 can influence both VA and MFT, while the presence of renal failure or hypertension can affect only the postoperative VA with high statistical significance difference at 1 month. The presence of heart failure or hyperlipidemia in diabetic patients can play a role in the MFT especially at 1 month.

 

Contact Details:

Email: mola_73@hotmail.com
Cell Phone: +966550886108

Maaly Abdel fattah