A study recently published in the Journal of Cataract & Refractive Surgery examined the risk of diabetic retinopathy (DR) progression and associated ophthalmic complications following Yttrium Aluminum Garnet (YAG) laser capsulotomy in patients with non-proliferative DR (NPDR) after cataract surgery.
Give me some background.
Although managing posterior capsule opacification (PCO) after cataract surgery is typically a routine procedure, the study authors noted that diabetic patients may be at risk for other complications after treatment.
- Plus: A recent study found that patients with type 1 and 2 diabetes (TD1 and TD2, respectively) were at higher risk for YAG capsulotomy following cataract surgery.
Meaning: Close follow-up of diabetic patients receiving surgical care after cataract extraction is required to identify potential complications early.
- “Given the anticipated increase in cataract surgeries, understanding the impact of YAG laser capsulotomy on DR progression enables a comprehensive risk assessment of these vulnerable patients,” the study authors added.
Now talk about the study.
In this retrospective cohort study, investigators utilized deidentified health records from 69 U.S. healthcare organizations across outpatient and academic ophthalmology settings.
- Who was included: Patients aged ≥18 years with TD1 or TD2 and NPDR who underwent cataract surgery with or without subsequent YAG laser capsulotomy.
Go on ...
Patients were followed for 1 year post-cataract surgery and propensity score matching (PSM) was utilized to balance baseline characteristics between cohorts.
Primary outcomes measures: The need for panretinal photocoagulation (PRP) or pars plana vitrectomy (PPV) and the development of:
- Proliferative DR (PDR)
- Vitreous hemorrhage (VH)
- Tractional retinal detachment (TRD)
- Neovascular glaucoma (NVG)
Findings?
In total: 10,750 patients (10,750 eyes) were included after matching (5,375 per cohort).
At year 1, YAG-treated patients had a higher risk of the following:
- TRD (hazard ratio [HR]: 2.04, 95% confidence interval [CI]: 1.32-3.13)
- PDR (HR: 1.91, 95% CI: 1.67-2.18)
- PRP (HR: 1.48, 95% CI: 1.14-1.91)
- VH (HR: 1.40, 95% CI: 1.15-1.72)
Additionally: A secondary analysis of patients with ≥5 years of NPDR showed similar elevated risks, while no significant difference was observed between the two groups regarding the risk of needing PPV.
Now to the take home.
These findings demonstrate that YAG laser capsulotomy in patients with NPDR is associated with increased risk of DR progression and vision-threatening complications.
The recommendation: Ophthalmic screening and close follow-up of this population following YAG treatment.
As for next steps: The study authors explained that future studies should explore how the following factors influence these outcomes:
- Age
- NPDR stage
- Laser settings