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Diabetic Nephropathy, Glycemic Control and Pseudophakic Macular Edema After Cataract Surgery

Active Not RecruitingN/A

Sponsor: Thammasart University Hospital

Conditions: Pseudophakic Macular Edema, Diabetic Nephropathies, Diabetes Mellitus, Type 2, Cataract (Post-operative Cataract Surgery Follow-up), Cataract and IOL Surgery

Interventions: Phacoemulsification with posterior-chamber IOL

Countries: Thailand

This retrospective cohort study examines whether the kidney complications of diabetes (diabetic nephropathy) and blood-sugar control before surgery help predict swelling of the central retina, called pseudophakic macular edema (PME), after cataract surgery in people with type 2 diabetes. PME is a common cause of blurred vision after otherwise successful cataract surgery, and people with diabetes are at higher risk. Doctors currently estimate this risk mainly from the HbA1c blood-sugar level and the stage of diabetic eye disease (retinopathy). It is not yet known whether diabetic kidney disease, measured by the urine albumin-to-creatinine ratio (UACR) and estimated kidney function (eGFR), adds independent information about who will develop PME. Using medical records already collected during routine care at Thammasat University Hospital, the investigators will measure central retinal thickness on optical coherence tomography (OCT) scans before uncomplicated phacoemulsification cataract surgery with a lens implant, and again 1 and 3 months afterward. PME is defined as at least a 30% increase in central macular thickness. Patients with and without baseline diabetic nephropathy will be compared, and statistical modeling will identify the best preoperative HbA1c threshold for predicting PME. The results are intended to improve preoperative risk counseling and to help identify diabetic patients who may need closer monitoring after cataract surgery. Because only existing records are used, the study involves no additional visits, tests, or risks for patients.

Eligibility overview

Sex: ALL

Age: 18 Years to —

Healthy volunteers: No

Study type: OBSERVATIONAL

Eligibility criteria

Inclusion Criteria:

* Diagnosis of type 2 diabetes mellitus at the time of surgery
* Aged ≥18 years
* Underwent uncomplicated phacoemulsification with posterior-chamber IOL implantation at TUH during the study period
* Preoperative HbA1c documented within 3 months before surgery
* Preoperative renal function within 6 months before surgery: serum creatinine (for CKD-EPI 2021 eGFR) and/or spot urine albumin-creatinine ratio (UACR)
* Baseline spectral-domain macular OCT within 1 month before surgery
* Postoperative OCT available at both 1 month and 3 months after surgery
* Minimum 3 months of postoperative follow-up documented

Exclusion Criteria:

* Pre-existing macular disease (age-related macular degeneration, epiretinal membrane, macular hole, central serous chorioretinopathy, or clinically significant diabetic macular edema at the time of surgery)
* Intraoperative complication (posterior-capsule rupture, vitreous loss, zonulolysis, or dropped nucleus)
* Prior intraocular surgery in the study eye (vitrectomy, glaucoma surgery, or previous cataract surgery)
* Prior intravitreal injection before cataract surgery
* Prior posterior-segment or macular laser photocoagulation within 6 months before surgery
* Uveitis, retinal vein occlusion, retinal detachment, or any non-diabetic retinal pathology
* Prostaglandin-analogue use at the time of surgery
* Type 1 diabetes mellitus (may be examined in a sensitivity analysis)
* Insufficient data (missing HbA1c, renal function, or postoperative OCT)
* Bilateral simultaneous surgery (only the first operated eye is included if surgery is sequential)

Locations (1)

Pathum Thani, Khlong Luang, Thailand