The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema

• Published in: British journal of ophthalmology Vol. 101; no. 12; p. 1673
• Main Authors: Denniston, Alastair K, Chakravarthy, Usha, Zhu, Haogang, Lee, Aaron Y, Crabb, David P, Tufail, Adnan, Bailey, Clare, Akerele, Toks, Al-Husainy, Sahar, Brand, Christopher, Downey, Louise, Fitt, Alan, Khan, Rehna, Kumar, Vineeth, Lobo, Aires, Mahmood, Sajjad, Mandal, Kaveri, Mckibbin, Martin, Menon, Geeta, Natha, Salim, Ong, Jong Min, Tsaloumas, Marie D, Varma, Atul, Wilkinson, Elizabeth, Johnston, Robert L, Egan, Catherine A
• Format: Journal Article
• Language: English
• Published: England 01-12-2017
• Subjects: Aged; Cataract - complications; Cataract Extraction; Diabetic Retinopathy - complications; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - therapy; Electronic Health Records; Female; Follow-Up Studies; Humans; Macular Edema - diagnosis; Macular Edema - etiology; Macular Edema - therapy; Male; Middle Aged; Outcome Assessment, Health Care; Postoperative Period; Time Factors; Tomography, Optical Coherence; United Kingdom; Visual Acuity; United Kingdom; Diabetic retinopathy; Cataract; Intravitreal therapy; Diabetic macular oedema; Electronic medical record
• ISSN: 1468-2079
• DOI: 10.1136/bjophthalmol-2016-309838

To assess the rate of 'treatment-requiring diabetic macular oedema (DMO)' in eyes for the two  years before and after cataract surgery.
Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system.
eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy.
rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye.
4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of 'treatment-requiring DMO' increased sharply after surgery, peaking in the 3-6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0-3, 3-6, 6-9 and 9-12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01).
This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3-6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.