Eyes from Type 1 diabetes patients are associated with higher post-operative complications rates than those from Type 2 diabetes patients

Abstract

AbstractObjective To assess the effect of the type of diabetes on the formation of pseudophakic cystoid macular edema (PCME) and posterior capsular opacification (PCO) following cataract surgery. Methods Cohort study of patients who underwent cataract extraction at the Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK, between 2003 and 2017. The rate of PCME and Nd:YAG laser capsulotomies following cataract surgery were assessed and compared between non-diabetic, type 1 (DM1) and type 2 diabetes (DM2) patients. Multivariate Cox regression controlling for age and gender was used to estimate hazard ratios (HR) for Nd:YAG laser capsulotomies. Results Included were 53,471 consecutive cataract surgeries (21,884 male and 31,587 female patients, with a mean age of 74.4 ± 10.9 years). Overall, 42,651 eyes (79.8%) were non-diabetic, 823 eyes (1.5%) of DM1, and 9997 eyes (18.7%) of DM2 patients. The mean follow-up time was 6.8 ± 4.2 years. PCME was found in 0.9% of non-diabetics, 2.1% of DM1, and 1.6% of DM2 patients (P = 0.003 and P < 0.001, respectively). In univariate analysis, the eyes of DM1 (P < 0.001) and DM2 (P = 0.003) patients had significantly higher Nd:YAG laser capsulotomy rates than the eyes of non-diabetic patients. In Cox regression analysis adjusted for the patient's age and gender, DM1 (HR 1.692, 95%CI 1.390–2.059, P < 0.001) and DM2 (HR 1.157, 95%CI 1.075–1.244, P < 0.001) remained significantly predictive for higher Nd:YAG laser capsulotomy rates. Conclusions In our large cohort study, DM1 predisposed to high risk for developing PCME and PCO following cataract surgery. These findings could expand our knowledge of the underlying mechanisms, preventive measures and therapeutic targets against late-onset complications.