Deborah K. Schlossman

Cataract Surgery and its Complications in Diabetic Patients

Abstract Diabetic patients are known to have an increased risk of cataract development and cataract surgery is a common surgical procedure for diabetic individuals. Cataract extraction (CE) in diabetic patients as compared to non-diabetic patients is associated with higher risks of reported complications such as capsular contraction and opacification as well as post-surgical worsening of macular edema (ME) and diabetic retinopathy (DR). In this paper, we review the pathogenesis of diabetic cataract, the risk factors contributing to cataract complications as well as DR progression, and assess preventive measures and treatment options for DR and ME following CE.

Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes.

Purpose: To compare visual acuity outcomes and diabetic retinopathy progression after pars plana vitrectomy (PPV) versus combined pars plana vitrectomy and phacoemulsification (PPVCE) in patients with diabetes. Methods: Retrospective review of 222 consecutive diabetic patients undergoing PPV or PPVCE. Results: A total of 251 eyes of 222 patients were evaluated (PPV = 122, PPVCE = 129). Four-year follow-up was 64% (161 eyes). Overall, patients undergoing PPVCE had better preoperative visual acuity (PPVCE = 20/80, PPV = 20/160, P = 0.03). At 4-year follow-up, visual acuity improved (PPV = +22, PPVCE = +11 letters) compared with baseline in both groups. After correcting for baseline differences in visual acuity, no statistically significant difference in final visual acuity was observed (PPVCE = 20/32, PPV = 20/50, P = 0.09). Results did not differ substantially by surgical indication (vitreous hemorrhage, traction retinal detachment, epiretinal membrane, and/or diabetic macular edema). Cataract progression occurred in 64%, and cataract surgery was performed in 39% of phakic eyes undergoing PPV. Rates of diabetic retinopathy progression, vitreous hemorrhage, and retinal detachment were not statistically different. Neovascular glaucoma developed in 2 patients (2%) after PPV and 6 patients (8%) after PPVCE (P = 0.07). Conclusion: In diabetic patients, equivalent visual acuity improvement over 4 years was observed after PPV or PPVCE. Visual outcomes and retinopathy progression rates were not significantly different after either intervention, suggesting that PPVCE may be appropriate when indicated in patients with diabetes.

Gastric Bypass Surgery in Severely Obese Women With Type 1 Diabetes: Anthropometric and Cardiometabolic Effects at 1 and 5 Years Postsurgery

While the benefits of gastric bypass (GB) surgery in type 2 diabetes are well established, few studies have evaluated the long-term effects of GB in patients with type 1 diabetes (1,2), and these studies demonstrate conflicting effects on glycemic control. This is clinically important given the increasing prevalence of obesity in patients with type 1 diabetes (3). We studied 10 severely obese women with confirmed type 1 diabetes, as previously described (4), and evaluated outcomes prior to GB and at 1 and 5 years following surgery. Mean age at GB was 39.6 ± 8.4 years, mean duration of type 1 diabetes 24.6 ± 10.1 years, and mean age at diagnosis 16.0 ± 8.3 years. Six subjects used continuous subcutaneous insulin infusion. BMI decreased by 33% from baseline at 1 year postoperatively (from 43.5 ± 7.5 to 29.3 ± 5.4 kg/m2, P < 0.0001) but …

Ultrawide field scanning laser ophthalmoscopy imaging of lipemia retinalis

To describe the characteristic retinal features of lipemia retinalis when using ultrawide field scanning laser ophthalmoscopy.