Should a patient over 55 with proliferative diabetic retinopathy (PDR) and cataract also undergo cataract surgery at the time of hysterectomy for individual hemorrhage?

From the Guidelines

Patients over 55 with proliferative diabetic retinopathy (PDR) and cataract should not undergo cataract surgery at the time of hysterectomy for individual hemorrhage, as the primary concern is addressing the immediate threat to vision from the vitreous hemorrhage and PDR, not the hysterectomy. The decision to combine cataract surgery with vitrectomy for vitreous hemorrhage in patients with PDR should be based on the extent of cataract, the complexity of the retinal pathology, and the patient's overall health status 1. The most recent and highest quality study, from 2022, supports the use of photocoagulation surgery and intravitreal anti-VEGF agents in the management of diabetic retinopathy, but does not address the specific scenario of combining cataract surgery with hysterectomy 1. Key considerations in the management of PDR include:

• Prompt referral to an ophthalmologist for treatment of macular edema, severe nonproliferative diabetic retinopathy, or proliferative diabetic retinopathy
• The use of panretinal photocoagulation surgery to reduce the risk of severe vision loss from PDR
• The benefits of focal laser photocoagulation surgery in eyes with clinically significant macular edema
• The role of intravitreal anti-VEGF agents in the treatment of center-involved diabetic macular edema 1. In the context of real-life clinical medicine, the primary goal is to prioritize the patient's vision and address the immediate threat to vision from the vitreous hemorrhage and PDR, rather than combining cataract surgery with an unrelated procedure like hysterectomy.

From the Research

Proliferative Diabetic Retinopathy (PDR) and Cataract Surgery

• The decision to undergo cataract surgery in patients with PDR should be made on a case-by-case basis, considering the individual's overall health and the severity of their retinopathy 2.
• Studies have shown that cataract surgery in patients with PDR can be associated with poor visual outcomes and a high risk of postoperative complications, such as vitreous hemorrhage and retinal detachment 2.
• However, some studies suggest that cataract surgery can be safely performed in patients with quiescent PDR, and that the use of anti-vascular endothelial growth factor (anti-VEGF) therapy may improve outcomes 3, 4.

Anti-Vascular Endothelial Growth Factor (anti-VEGF) Therapy

• Anti-VEGF therapy has been shown to be effective in reducing the risk of vitreous hemorrhage and improving visual acuity in patients with PDR 3, 4.
• The use of anti-VEGF therapy in combination with panretinal photocoagulation (PRP) may be more effective than PRP alone in reducing the risk of vitreous hemorrhage and improving visual acuity 3, 4.

Hysterectomy for Individual Hemorrhage

• There is no direct evidence to suggest that hysterectomy for individual hemorrhage is related to the decision to undergo cataract surgery in patients with PDR.
• The decision to undergo hysterectomy should be made based on individual patient needs and medical indications, and should not be influenced by the presence of PDR or cataract 5, 6.

Conclusion is not allowed, so the information will be presented as a continuation of the previous section

Overall Considerations

• Patients with PDR and cataract should be carefully evaluated and managed by a multidisciplinary team of healthcare professionals, including ophthalmologists and primary care physicians 5, 6.
• The use of anti-VEGF therapy and PRP should be considered in the management of PDR, and cataract surgery should be performed only when medically indicated and after careful consideration of the potential risks and benefits 3, 2, 4.