Development of diabetic retinopathy after cataract surgery

• Published in: PloS one Vol. 13; no. 8; p. e0202347
• Main Authors: Jeng, Chi-Juei, Hsieh, Yi-Ting, Yang, Chung-May, Yang, Chang-Hao, Lin, Cheng-Li, Wang, I-Jong
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.08.2018; Public Library of Science (PLoS)
• Subjects: Age; Aged; Angiotensin-converting enzyme inhibitors; Biology and Life Sciences; Care and treatment; Cataract - complications; Cataract - epidemiology; Cataract Extraction; Cataracts; Codes; Cohort Studies; Comorbidity; Complications; Complications and side effects; Confidence intervals; Cytokines; Development and progression; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic neuropathy; Diabetic retinopathy; Diabetic Retinopathy - epidemiology; Diabetics; Diagnosis; Dyslipidemia; Edema; Enzyme inhibitors; Eye surgery; Female; Health aspects; Health insurance; Hospitals; Humans; Hypoglycemic agents; Incidence; Insulin; Insulin - therapeutic use; Macular Edema - complications; Macular Edema - epidemiology; Male; Medicine; Medicine and Health Sciences; Metabolic disorders; Middle Aged; Patients; Peptidyl-dipeptidase A; Postoperative Complications - epidemiology; Precipitates; Regression analysis; Regression models; Retinopathy; Risk analysis; Risk Factors; Sex; Statins; Statistical analysis; Studies; Surgery; China; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202347

This study explored whether cataract surgery precipitates diabetic retinopathy (DR) development in diabetic patients without previous DR. Patients with the diagnosis of type II diabetes but without DR were selected from the Longitudinal Health Insurance Database 2000. Patients who received cataract surgery between January 1, 2000, and December 31, 2010, were included in the case group, and the control group was matched to the case group by age, sex, and index year. The postoperative incidence rates of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME) were the main outcomes studied and were adjusted by age, sex, comorbidities, and statin, fibrate, angiotensin-converting-enzyme inhibitor (ACEI), oral hypoglycemic agents (OHA), and insulin use. In our cohort, patients who had dyslipidemia and used statins were more likely to undergo cataract surgery. Among diabetic patients without previous DR, patients receiving cataract surgery had a higher risk of NDPR development (adjusted hazard ratio = 1.48, 95% confidence interval = 1.15-1.91). No statistical difference was observed in PDR or DME development between operative and nonoperative groups. In additional stratified analyses, female sex, older age, comorbidities, surgery within 5 years, statin, ACEI, OHA, and insulin use increased the risk of NPDR development. In an adjusted Cox regression model, cataract surgery, OHA and insulin use were found to be risk factors for NPDR development. Cataract surgery with complications increased post-operative risks for NPDR were even higher, and the significant influence from cataract surgery persisted 5 years after surgery.