Progression of diabetic retinopathy after cataract extraction

The course of diabetic retinopathy following cataract extraction was studied retrospectively in 89 patients (89 eyes). Cataract extraction was extracapsular in 12 eyes (13.5%), extracapsular with intraocular lens implantation in 37 (41.6%), and intracapsular in 40 (45%). In 55 eyes (61.8%) there was no change in the retinal status after surgery, and in 34 (38.2%) there was progression of diabetic retinopathy. In the eyes showing progression there was appearance or aggravation of non-proliferative changes in 85-3% and development of proliferative diabetic retinopathy in 14-7%. Most of these eyes (91%) deteriorated within six months of surgery. Risk factors for the progression of diabetic retinopathy were the preoperative existence of diabetic retinopathy p<0005) and the need for antidiabetic agents in addition to dietary control in the management of diabetes (p<0.025). Ophthalmology Department, Kaplan Hospital, Rehovot, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel A Pollock S Dotan M Oliver Correspondence to: A Pollack, MD, Ophthalmology Department, Kaplan Hospital, 76100 Rehovot, Israel. Accepted for publication 8 March 1991 Diabetes mellitus occurs in an estimated 2-3% of the population in the United States.' This means that the number of diabetic patients undergoing cataract surgery every year is relatively large and is expected to increase even further with the gradual rise in life expectancy of diabetic patients owing to improved medical management. The effect of cataract surgery on the postoperative course of diabetic retinopathy is unclear. Jaffe and Burton2 reported the development of a severe exudative form of diabetic macular oedema following cataract extraction. We have recently described the pattern of deterioration of diabetic retinopathy after cataract surgery.3 Other authors' have also described postoperative progression of diabetic retinopathy resulting in poor vision. In contrast, Sebestyen7 found that cataract surgery was not associated with the progression of diabetic retinopathy, as in his series of patients similar progression was observed also in the unoperated fellow eye. The purpose of this retrospective study was to examine the relationship between cataract surgery and the postoperative course of diabetic