The first experience of combined treatment of patients with diabetic macular edema and complicated cataract

• Main Authors: A. V. Tereshchenko, I. G. Trifanenkova, Y. A. Sidorova, E. V. Erokhina, M. V. Okuneva, V. V. Firsova
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2018-11-01
• Series: Офтальмохирургия
• Subjects: diabetic macular edema; cataract; combined treatment; phacoemulsification of cataract; ozurdex implant
• Online Access: https://www.ophthalmosurgery.ru/jour/article/view/441

Diabetic cataracts in combination with diabetic macular edema (DME) is a leading cause of vision loss i n patients with diabetes mellitus.Purpose. To evaluate the efficacy and safety of one-stage combined treatment of patients with diabetes complicated by DME and cat aract.Material and methods. This study involved 16 patients with diabetes of the type 2 (32 eyes). The main group included 16 eyes with complicated cataracts, who underwent the simultaneously performed phacoemulsification of cataract (FEC) with IOL implantation and intravitreal implantation of the «Ozurdex» implant. The second (retrospective control) group included 16 fellow eyes, where a standard FEC with IOL implantation was performed.Results. Six months after the treatment, the main group showed a BCVA stabilization at a level 0.25±0.12 (0.1-0.4). In the  retrospective group, the BCVA decreased and reached a baseline level 0.1±0.05 (0.05-0.2), in 5 patients the BCVA became below the baseline values. In all cases in the main group, a partial resorption of «solid» exudates was observed in the macular area. Edema of the retina decreased by 102-275 microns in comparison with preoperative indicators, the average retinal thickness was 385±58 microns in fovea area. Diffuse macular edema with a deposition of «solid» exudates remained in the retrospective control group, all patients had an increase in the amount of intra-etinal hemorrhages. In 5 patients, not only an increase in the number of «solid» exudates was revealed in the dynamics, but also their spread to the fovea region, in 3 cases the exudation foci acquired the form of hyper-reflective layers. The increase in the edema height occurred in all cases by 74-144 microns, index of average retinal thickness was 598±76 microns. In 7 cases, the dynamics showed an increase in flat subfoveal detachments of the neurosensory retina.Conclusions. The complex effect of the OzurDex drug in the combined treatment of diabetic cataracts in combination with DME reduces a risk of inflammatory complications in the early postoperative period, and also provides a reduction in the height of edema and partial resorption of «solid» exudates.