EXTRACAPSULAR CATARACT-EXTRACTION IN PROLIFERATIVE DIABETIC-RETINOPATHY

Purpose: To establish the visual prognosis, prevalence of complications, and optimal strategy for management of proliferative diabetic retinopathy (PDR) in isolated extracapsular cataract extraction (ECCE). Method: This is a retrospective review of 56 patients with PDR who underwent ECCE with lens implantation. Results were compared with 64 patients with background diabetic retinopathy (BDR) operated on during the same time period. Results: Final visual acuity (67% greater-than-or-equal-to 20/40) was better in BDR eyes compared with PDR eyes (21% greater-than-or-equal-to 20/40; P < 0.001). In eyes without maculopathy, 94% with BDR achieved a final visual acuity of at least 20/40 compared with 52% with quiescent proliferative retinopathy (P < 0.001). Final visual acuity in eyes with maculopathy was better in BDR eyes (36% greater-than-or-equal-to 20/40) than in PDR eyes (5% greater-than-or-equal-to 20/40) (P < 0.02). No patient with active proliferative or preproliferative retinopathy achieved a final visual acuity of more than 20/80. Postoperative deterioration of retinopathy occurred in 50% of patients with active proliferative retinopathy compared with 10% with quiescent proliferative retinopathy (P < 0.01) and 3% with BDR (P < 0.001). Immediate postoperative fibrinous anterior uveitis, which prevented early panretinal photocoagulation, developed in over half the patients with active proliferative retinopathy. Conclusions: Final visual acuity after cataract extraction in diabetic patients with proliferative retinopathy is generally poor; however, in patients with quiescent proliferative retinopathy and no maculopathy, visual acuity may be good. Active proliferative retinopathy at the time of surgery is a poor prognostic indicator for final visual acuity and is associated with postoperative deterioration of retinopathy and fibrinous uveitis, which may preclude immediate postoperative panretinal photocoagulation.