Cataract Surgery in Diabetics

What is Cataract Surgery in Diabetics?

Diabetes is a chronic metabolic disorder characterised by hyperglycemia or presence of high sugar (glucose) levels in the blood. It is one of the main factors that cause development of cataracts. An estimated 60 per cent of the people with diabetes are at increased risk of developing cataracts.

Diabetes is a progressive systemic disorder and patients who require cataract surgery often have coexisting diabetic eye conditions. Normally in a healthy eye, present-day cataract surgeries can restore perfect vision and correct conditions such as nearsightedness, farsightedness, and astigmatism. But when you have a coexisting diabetic eye condition, cataract surgery may add further stress to your eye and can result in macular oedema, limited vision, and progressive retinopathy.

Even though it is still feasible to deliver exceptional outcomes from cataract surgery in people with diabetes, these patients, however, are at increased risk of developing complications and subsequent vision limitations. With meticulous preoperative planning, attention to detail during cataract surgery, and close post-surgery supervision, diabetic patients can accomplish perfect vision after cataract surgery.

Cataract is a condition in which the natural lens of the eye becomes cloudy over time, causing blurred vision. Cataracts usually develop as a result of ageing. The natural lens of the eye is made up of protein and water and over time these proteins are altered ultimately causing gradual clouding of the lens and negatively impacting vision. Cataract surgery is the replacement of the cloudy natural lens with an artificial intraocular lens (IOL) implant to restore normal vision.

Preoperative Evaluation

People with diabetes go through the same process of preoperative evaluation as other patients with cataracts, but with additional importance placed on the presence and degree of diabetic eye changes one has incurred. Diabetic patients are inclined to develop cataracts in advance and may be additionally susceptible to develop posterior subcapsular cataracts than other patients, so they commonly present with cataracts at an early age. It is crucial to establish that the extent of cataract observed matches with the patients' visual acuity and reported visual impairment. If the patient reveals severe vision issues but the examination shows modest cataracts, then your doctor will carefully examine the retina to look for other causes of visual impairment.

Diabetics at any phase of the spectrum of retinopathy are prone to macular oedema, which is one of the chief causes of central vision loss in these patients. A dilated fundus evaluation can disclose many of these pathologies, but supplementary tests such as fluorescein angiography or optical coherence tomography (OCT) can disclose further subtle lesions. Notable diabetic ocular pathology must be treated before considering cataract surgery.

Preparation for Cataract Surgery in Diabetics

Your ophthalmologist will carry out a thorough preoperative evaluation prior to your cataract surgery and IOL placement, including:

  • A review of your medical history
  • A thorough eye exam to evaluate the overall health of your eyes and to study the shape and features of the eye in general
  • A refraction test to determine the degree of farsightedness, nearsightedness, and/or astigmatism
  • A measurement of the curvature of the pupils and cornea as well as the thickness of the cornea
  • A discussion about any medications or supplements you may be taking as some can complicate your cataract surgery
  • Avoiding wearing any eye makeup or face cream
  • Arranging for someone to drive you home after surgery
  • Signing an informed consent form after discussing the pros and cons of the procedure in detail with you

Procedure for Cataract Surgery in Diabetics

The surgical procedure for cataract removal and IOL implantation in diabetics is typically performed in an outpatient setting and does not need an overnight stay in a hospital or clinic facility.

There are three main types of cataract surgery: phacoemulsification, extracapsular cataract surgery, and intracapsular cataract surgery. Phacoemulsification is the most preferred technique of cataract removal, and in general, involves the following steps:

  • Your surgeon will first numb your eye with anaesthetic eye drops.
  • An eyelid holder will be placed on your eye to prevent the eye from blinking.
  • A small incision is made through your cornea using an operating microscope to access the lens.
  • A high-frequency ultrasound device is used to break up the cloudy natural lens into tiny pieces for easier removal.
  • Suction is used to gently remove the broken cloudy lens pieces from the eye.
  • A clear intraocular lens is carefully inserted behind the iris and pupil in the same place your natural lens had occupied.
  • The incision is then closed, and a protective shield is placed over the eye to complete the operation.

Postoperative Care Instructions and Recovery

In general, postoperative care instructions and recovery after cataract surgery in diabetics may involve the following:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs as you recover.
  • You will be prescribed medicated eye drops to be used for a few weeks to manage inflammation and other eye issues.
  • You should wear a protective eye shield for at least a week at night or while napping.
  • You should wear sunglasses to protect your eyes while outdoors.
  • Avoid strenuous activities and heavy lifting for a week so that there is no stress on the eye as it heals.
  • Keep away from dusty environments and avoid splashing water into your eyes for a week to reduce the risk of irritation and infection.
  • Avoid hot tubs or swimming and close your eyes while bathing or showering for a week.
  • If you have diabetes, keep it under control to prevent further retinal damage.
  • Do not drive until cleared by your ophthalmologist.
  • A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Cataract surgery in diabetics is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

  • Bleeding
  • Infection
  • Redness
  • Swelling
  • Retinal detachment
  • Displacement of the intraocular lens implant
  • Cystoid macular oedema
  • Endophthalmitis
  • Ocular synechiae and pupillary block
  • Capsular thickening
  • Vitreous haemorrhage
  • Remote chance of vision loss

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