From the Guidelines
Diabetic macular detachment (DMD) is a serious early post-operative complication of cataract surgery in patients with diabetes mellitus, and immediate referral to a retina specialist is essential for proper management, with treatment typically involving intravitreal anti-VEGF injections and possibly vitrectomy surgery 1. The management of DMD involves a comprehensive approach, including the use of intravitreal anti-VEGF injections such as bevacizumab (Avastin) 1.25mg/0.05mL, ranibizumab (Lucentis) 0.5mg/0.05mL, or aflibercept (Eylea) 2mg/0.05mL, which may be combined with topical steroids like prednisolone acetate 1% four times daily for 2-4 weeks. In severe cases, vitrectomy surgery may be necessary to manage the complication. The complication occurs due to increased inflammation and vascular permeability following cataract surgery, which exacerbates pre-existing diabetic retinopathy, as noted in the guidelines for diabetic eye care 1. Prevention strategies include optimizing glycemic control before surgery (aiming for HbA1c <7%), treating pre-existing diabetic retinopathy with laser photocoagulation or anti-VEGF therapy before cataract removal, and using prophylactic anti-inflammatory medications. Close post-operative monitoring is crucial, with follow-up examinations at 1 day, 1 week, and 1 month after surgery, with more frequent visits for high-risk patients, as recommended in the preferred practice pattern for cataract in the adult eye 1. Key considerations in the management of DMD include:
- Immediate referral to a retina specialist
- Use of intravitreal anti-VEGF injections
- Possible vitrectomy surgery in severe cases
- Optimization of glycemic control before surgery
- Treatment of pre-existing diabetic retinopathy before cataract removal
- Prophylactic anti-inflammatory medications
- Close post-operative monitoring.
From the Research
Cataract Surgery Early Post-Op Complication of DM Detachment
- Descemet's membrane detachment (DMD) is a complication that can occur after cataract surgery, and its management is crucial to prevent significant visual morbidity 2.
- The main risk factor for irreversible corneal edema and subsequent endothelial transplant appears to be direct endothelial trauma rather than the DMD itself 2.
- Small detachments may resolve with topical medical therapy within a few weeks to a few months, while larger detachments usually require surgical intervention 3.
- Surgical intervention, such as anterior chamber tamponade with air, can be effective in reattaching Descemet's membrane and improving visual acuity 3, 4, 5.
- The decision to choose a conservative or surgical approach depends on the height, length, and extent of the detachment, as well as its localization in relation to the optical axis 5, 6.
- Repeated injection of air into the anterior chamber may be necessary until reattachment of Descemet's membrane is achieved and the cornea becomes clear again 5.
- Early surgical intervention, especially for scrolled, extensive, and sight-disabling DMDs, may be favored by many surgeons, but the optimal timing and nature of surgical intervention are not yet fully defined 6.