Does phacoemulsification speed the progression of diabetic retinopathy? A meta-analysis

The objective of the present study is to evaluate the influence of phacoemulsification on postoperative progression of diabetic retinopathy and incidence of diabetic macular edema in patients with diabetes and cataract. To perform a meta-analysis for this study, the computerized databases including Medline, Embase and Cochrane library were searched to identify eligible studies, in which patients with diabetes and cataract received phacoemulsification in one eye and the non-operated contralateral eye was considered as the control group. The progression rate of diabetic retinopathy and incidence of diabetic macular edema in two study groups were extracted from the enrolled articles. Statistical analyses were performed using CMA-2 software, where dichotomous variables were expressed as odds ratio (OR) and 95% confidence intervals. As a result, a total of 7 articles were eventually included in this meta-analysis. Both the progression rate of diabetic retinopathy and incidence of diabetic macular edema in the operated eye after phacoemulsification (OR=1.53, 95% CI: 1.04-2.26, P=0.03) was higher than the non-operated contralateral control (OR=1.86, 95% CI: 1.03-3.37, P=0.04). Heterogeneity and publication bias was measured. The results showed that phacoemulsification tends to accelerate the progression of diabetic retinopathy and increase the incidence of diabetic macular edema in patients with cataract. These findings will need to be confirmed in a large sample and long follow-up studies.