 |
|
Results After Lens Extraction in Patients With Diabetic Retinopathy
Early Treatment Diabetic Retinopathy Study Report Number 25
Emily Y. Chew, MD;
William E. Benson, MD;
Nancy A. Remaley, MS;
Anna A. Lindley, PhD;
Thomas C. Burton, MD;
Karl Csaky, MD, PhD;
George A. Williams, MD;
Frederick L. Ferris III, MD;
for the Early Treatment Diabetic Retinopathy Study Research Group
Arch Ophthalmol. 1999;117:1600-1606.
Objective To assess the visual results after surgical lens removal in patients with diabetic retinopathy.
Design A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema.
Participants Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years.
Outcome Measurements Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed.
Results The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adjusted analyses (P=.03). No statistically significant long-term increased risk of macular edema was documented after lens surgery.
Conclusions Visual acuity results after lens surgery in patients in the Early Treatment Diabetic Retinopathy Study were better than published results for similar patients. This may be because of more intensive photocoagulation for lesions of diabetic retinopathy in the Early Treatment Diabetic Retinopathy Study than in previously reported studies. Although patients with severe nonproliferative retinopathy or worse before lens surgery had poorer visual results, visual improvement was seen in 55% of these patients at 1-year follow-up. The main causes of poor visual results in eyes after lens surgery were complications of proliferative retinopathy and/or macular edema.
From the Division of Biometry and Epidemiology (Drs Chew, Lindley, and Ferris and Ms Remaley) and Laboratory of Immunology (Dr Csaky), National Eye Institute, National Institutes of Health, Bethesda, Md; Jefferson Medical College, Philadelphia, Pa (Dr Benson); and William Beaumont Hospital, Royal Oak, Mich (Dr Williams). Dr Burton is in private practice in Milwaukee, Wis. A list of the Early Treatment Diabetic Retinopathy Study investigators appears at the end of ETDRS Report No. 7 (Ophthalmology 1991;98:741-756).
RELATED ARTICLE
Archives of Ophthalmology Reader's Choice: Continuing Medical Education
Arch Ophthalmol. 1999;117(12):1673-1674.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Metabolic Control of Diabetes Is Associated With an Improved Response of Diabetic Retinopathy to Panretinal Photocoagulation
Kotoula et al.
Diabetes Care 2005;28:2454-2457.
ABSTRACT
| FULL TEXT
An overview of the eye in diabetes
Negi and Vernon
JRSM 2003;96:266-272.
ABSTRACT
| FULL TEXT
A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes
Squirrell et al.
Br. J. Ophthalmol. 2002;86:565-571.
ABSTRACT
| FULL TEXT
|
