Preoperative macular thickness in patients with diabetes correlates with macular changes after cataract surgery
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LETTER TO THE EDITOR
Preoperative macular thickness in patients with diabetes correlates with macular changes after cataract surgery Piotr Kanclerz 1 & Idan Hecht 2,3 & Raimo Tuuminen 3,4 Received: 25 September 2020 / Revised: 25 September 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, We have read the article by Doncel-Fernández et al. [1] in which the authors have determined the association between central macular thickness (CMT) and the risk for developing cystoid macular edema (CME) after uncomplicated cataract surgery. The study found that patients with pre-surgical macular thickness > 260.5 μm, measured by Cirrus Optical Coherence Tomography (OCT; Carl Zeiss Meditec AG, Jena, Germany), were ninefold more likely to develop macular intraretinal cysts postoperatively. The number of enrolled patients, those that completed the study, and the number of those with diabetes remained somewhat unclear [1]. Interestingly, on the other hand cataract removal may positively influence glycemic control in type 2 diabetic patients without maculopathy [2]. In the light of these findings, we attempted to independently verify these results. We performed a multivariate logistic regression of recognized and potential factors influencing retinal thickness following cataract surgery. A post hoc analysis of our previously published study involved 95 eyes of 93 patients with diabetes undergoing routine cataract surgery at the Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland [3]. CMT, corresponding to mean macular thickness in the central 1000μm2 area, was recorded preoperatively by spectral-domain OCT (Spectralis, * Raimo Tuuminen [email protected] 1
Hygeia Clinic, Gdańsk, Poland
2
Department of Ophthalmology, Shamir Medical Center, Tel Aviv, Israel
3
Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
4
Department of Ophthalmology, Kymenlaakso Central Hospital, Kotkantie 41, FI-48210 Kotka, Finland
Heidelberg Engineering GmbH, Heidelberg, Germany) and at 1-month after surgery by an experienced ophthalmic nurse. The postoperative anti-inflammatory medication was steroids (dexamethasone 1 mg/ml, Oftan® Dexa, Santen, Tampere, Finland) three times a day for 3 weeks, and in some cases NSAIDs (nepafenac 1 mg/ml, Nevanac®, Novartis, Basel, Switzerland) were recommended based on the surgeon’s discretion. We found that preoperative CMT was 287.9 ± 55.6 μm (mean ± SD) and that every micrometer of preoperative CMT correlated with a CMT increase of 0.089 μm (95% CI = 0.005–0.174 μm, p = 0.038; Table 1). Furthermore, the preoperative HbA1c level and presence of diabetic retinopathy were independent risk factors for CMT increase 1 month after cataract surgery (Table 1). In general, preoperative OCT imaging before routine cataract surgery is not considered costeffective [4]. In select populations such as patients with diabetes, preoperative OCT imaging before cataract surgery in assessing the risk for d
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