Panretinal photocoagulation during cataract extraction in eyes with active proliferative diabetic eye disease.
OBJECTIVE
Cataract surgery in the presence of active proliferative diabetic eye disease carries a high risk of progression of retinopathy and neovascular glaucoma. Lens opacities may prevent panretinal photocoagulation (PRP) before surgery, and applying PRP in the immediate post-operative period can be difficult. The purpose of this study is to report results of cataract extraction combined with per-operative indirect laser PRP in a group of these patients.


METHODS
Nine eyes of 9 diabetic patients with active retinal or iris neovascularisation in which lens opacities prevented adequate pre-operative PRP underwent cataract surgery combined with indirect laser PRP after cortex aspiration and before intraocular lens implantation.


RESULTS
Regression of neovascularisation with this combined procedure alone was achieved in 5 eyes, 3 responded to further PRP, and 1 developed neovascular glaucoma. Visual acuity improved in all eyes, 4 achieving > or = 6/12. Four patients developed increased post-operative uveitis. One developed clinically significant macular oedema.


CONCLUSIONS
The method described has definite practical advantages over PRP attempted in the immediate post-operative period, when many factors can prevent its application or reduce its effectiveness, and when neovascularisation may be progressing rapidly. In addition, adjunctive per-operative indirect laser PRP appears to improve the outcome of cataract surgery in eyes with active proliferative diabetic eye disease.
West
J A
JA
Moorfields Eye Hospital, London, UK.
Dowler
J G
JG
Hamilton
A M
AM
Boyd
S R
SR
Hykin
P G
PG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000009:adverse effects; D003930:Diabetic Retinopathy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015861:Retinal Neovascularization / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014605:Uveitis / Q000209:etiology; D014792:Visual Acuity