The Effect of Phacoemulsification Cataract Surgery on the Onset and Progression of Diabetic Retinopathy in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Danika Corless BAppSc MOrth¹, ²

Linda Malesic PhD¹

Konstandina Koklanis PhD¹

¹ Discipline of Orthoptics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia

² Retina Specialists Victoria, Melbourne, Australia

ABSTRACT

Purpose: To systematically review the literature on the onset or progression of diabetic retinopathy in patients with type 2 diabetes, following phacoemulsification.

Methods: A systematic search of PubMed, CINAHL and EMBASE was conducted. The database search was from 1995 to 2020. Prospective and retrospective observational studies of human participants with a minimum follow-up period of 12 months were included. Citation chaining of all included studies was also performed. No restriction was placed on the duration, control of diabetes or stage of diabetic retinopathy. All included articles were assessed for risk of bias using the Critical Appraisal Skills Programme (CASP) checklist. Pooled odds ratios (ORs) and 95% CIs were calculated using a fixed-effect, Mantel-Haenszel analysis.

Results: A total of six articles met the inclusion criteria. Four were prospective observational studies and two were retrospective. All studies utilised the fellow eye as a control with a follow-up period ranging from 12 to 36 months. The overall pooled odds ratio was 1.34, 95% CI [0.93, 1.94], p=0.12 and showed no statistically significant difference between the phacoemulsification and control group.

Conclusion: This systematic review and meta-analysis suggest that phacoemulsification surgery does not increase the risk of diabetic retinopathy progression or its onset in patients with type 2 diabetes. Significant developments in surgical technique advancing from extracapsular cataract extraction to phacoemulsification, which has assisted in reducing the resulting postoperative inflammation, likely explains these findings. Further studies with longer follow-up duration, larger sample size, more ethnically diverse population groups and that control for known confounding factors will help strengthen this evidence.