Is There a Safe Glycemic Threshold for Cataract Surgery?

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-03 DOI:10.1016/j.ajo.2025.04.033

ZAIN S. HUSSAIN , AHMED F. SHAKARCHI , MUHAMMAD Z. CHAUHAN , DANE A. JESTER , MOHAMED K. SOLIMAN , AHMED B. SALLAM

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引用次数: 0

Abstract

Objective

To assess the relationship between cataract surgery and the 30-day incidence of post-operative endophthalmitis (POE) (analysis 1) and serious systemic adverse events (analysis 2) in diabetic patients with varying preoperative hemoglobin A1c (HbA1c) levels.

Design

Retrospective, longitudinal cohort study; multicenter study using a global federated database of electronic health records.

Subjects and Controls

Adults (≥18 years) with type 1 or type 2 diabetes mellitus who underwent phacoemulsification cataract surgery. Control groups in analysis 1 were patients without diabetes who underwent cataract surgery. Control groups in analysis 2 were diabetic patients with similar HbA1c who had a routine eye examination without cataract surgery.

Intervention

Cataract surgery.

Main Outcomes Measures

The primary outcomes were 30-day incidence of: (1) POE, defined by ICD-10 codes; and (2) serious systemic adverse events, including mortality, stroke/transient ischemic attack, major cardiovascular events, and a composite outcome of these events. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards models.

Results

In analysis 1, the risk of POE within 30 days post-cataract surgery did not differ significantly across HbA1c levels compared to non-diabetic controls. The HRs were 0.62 (95% CI, 0.30-1.27) for good HbA1c level (<7%), 1.08 (95% CI, 0.44-2.66) for moderate (7%-8.4%), 1.36 (95% CI, 0.43-4.28) for poor (8.5%-11.3%), and 2.85 (95% CI, 0.29-27.44) for very poor HbA1c (>11.3%). In analysis 2, the HRs for the 30-day composite outcome of any systemic events were not significantly different across HbA1c levels compared to controls. The 90-day analyses showed similar results for systemic events.

Conclusions

Cataract surgery does not appear to increase the risk of POE or serious systemic adverse events in diabetic patients across all HbA1c levels. These findings suggest that HbA1c alone should not be a reason to defer cataract surgery and highlight the need for individualized risk assessments to determine surgical fitness.

查看原文本刊更多论文

白内障手术是否存在安全的血糖阈值？

目的探讨术前血红蛋白A1c （HbA1c）水平不同的糖尿病患者白内障手术与术后30天眼内炎（POE）（分析1）及严重全身不良事件（分析2）发生率的关系。设计：回顾性、纵向队列研究；使用全球电子健康记录联邦数据库的多中心研究。受试者和对照组：接受白内障超声乳化手术的1型或2型糖尿病成人（≥18岁）。分析1的对照组是接受白内障手术的非糖尿病患者。分析2的对照组为糖化血红蛋白相似且未做白内障手术的糖尿病患者。INTERVENTIONCataract手术。主要结局指标：主要结局指标为30天的POE发生率：(1)POE，由ICD-10编码定义；(2)严重的全身不良事件，包括死亡、中风/短暂性脑缺血发作、主要心血管事件以及这些事件的复合结局。采用Cox比例风险模型计算风险比（hr）和95% ci。结果在分析1中，与非糖尿病对照组相比，不同HbA1c水平的患者白内障术后30天内发生POE的风险无显著差异。良好的HbA1c水平（11.3%）的hr为0.62 （95% CI, 0.30-1.27）。在分析2中，HbA1c水平与对照组相比，任何系统性事件的30天综合结果的hr没有显著差异。90天的分析对系统性事件也显示出类似的结果。结论：在所有HbA1c水平的糖尿病患者中，白内障手术似乎不会增加POE或严重全身不良事件的风险。这些发现表明，单凭糖化血红蛋白不应成为推迟白内障手术的原因，并强调需要进行个体化风险评估以确定手术是否适合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.