Effect of perioperative glycemic control in progression of diabetic retinopathy and maculopathy.
OBJECTIVE: To evaluate the contribution of perioperative glycemic control to progression of diabetic retinopathy and maculopathy. METHODS: Postoperative progression of diabetic retinopathy and maculopathy were compared in 87 patients with type 2 diabetes mellitus who underwent monocular phacoemulsification cataract surgery performed by a single surgeon. Twenty-seven patients had had poor glycemic control preoperatively and underwent rapid preoperative glycemic correction; 30 patients had poor control preoperatively that was not corrected postoperatively; and 30 patients had good preoperative glycemic control. The grade of diabetic retinopathy and maculopathy in the operated-on eye and the fellow eye was assessed preoperatively and for 12 months postoperatively. RESULTS: There were no significant differences in the progression rate of diabetic retinopathy among the 3 groups (P = .27). However, the progression rate of diabetic maculopathy was significantly higher in the group that underwent rapid control than in the other 2 groups (P = .02). Patients with moderate to severe nonproliferative diabetic retinopathy preoperatively in the rapid control group had significantly higher progression rates of diabetic retinopathy and maculopathy (P = .002 and .008, respectively). CONCLUSIONS: Rapid preoperative glycemic control should be avoided in patients with moderate to severe nonproliferative diabetic retinopathy because it may increase the risk of postoperative progression of retinopathy and maculopathy.