Use of Audit cycle to improve outcomes of cataract surgery in diabetic patients

Author: Ritu Chaturvedi (United Kingdom)

Co-authors: Natasha Peat, Hedayat Javidi, Tim De Klerk, Sajjad Mahmood, Habiba Saedon

Purpose

Cystoid macular edema (CMO) is a leading cause of suboptimal visual outcome after cataract surgery. Pre-existing diabetes is a known risk factor. Treatment of post-operative CMO can be invasive with potential complications. Thus, a study was designed to enable the development of strategies focussed on prevention of CMO in first place.

Setting/Venue

The study was conducted at a designated cataract unit under Manchester Royal Eye Hospital.

Methods

An audit of the incidence of CMO following cataract surgery was done. Since 25% of the CMO in the study population were noted in diabetic patients, routine prophylactic NSAIDs were prescribed for all diabetic patients. A reaudit of consecutive patients over an eight-month period was conducted to assess the effectiveness of the preventive treatment paradigm.

Results

A total of 1086 patients were seen in the reaudit cycle with 16 patients developing post-operative CMO (1.47%). Amongst these 3 patients (19%) were diabetic. Risk estimation was done based on Manchester PCT/council information. Since 5.5% of population is diabetic, we expect 60 patients in our cohort to have diabetes. This can be extrapolated to a 5.0% overall risk of CMO in diabetic patients who had received preventive treatment with NSAIDS. In the group that had not received the NSAIDS, the overall risk was found to be 7%. In most cases (94%), CMO resolved with topical treatment alone. All patients had an improvement in vision post-operatively.

Conlusions

Although there was a reduction in incidence of post-operative CMO following treatment with NSAIDS in diabetic patients from 25% to 19%, this was not statistically significant. Thus, new guidelines have been produced targeting only high-risk diabetic patients with R2 or R3 retinopathy and those with pre-existing CMO for preventive NSAID treatment.

Financial Disclosure

NOT APPLICABLE