Clinical outcomes and associated risk factors of cataract surgeries in patients with diabetic macular edema: A real-world study

Purpose: To evaluate the clinical outcome of phacoemulsification with intravitreal bevacizumab (IVB) injection in patients with cataract and diabetic macular edema (DME) and to evaluate the risk factors for poor visual outcome. Methods: Retrospective study of 63 eyes of 60 patients with cataract and DME who underwent phacoemulsification with IVB injection. Best corrected visual acuity (BCVA) and central macular thickness (CMT) over 3 months were studied. Univariate binary logistic regression was done to assess the risk factors for poor visual outcome (BCVA <6/60) at the 3 months. Results: The mean baseline BCVA in log Mar scale ± SD was 0.94 ± 0.58. The mean BCVA at 3 weeks after the surgery was 0.52 ±0.47, and at 3 months was 0.49±0.37. At 3 weeks, the mean CMT (N = 47) was 437.27±217.48 compared with the mean preoperative CMT of 380.87±176.38 in the same set (P = 0.01). The mean CMT at 3 months was 457.97 ± 206.94 (N=40) compared to preoperative mean CMT 435.45 ± 146.13 in the same set (p value 0.52). Fifteen eyes (23.8%) were given a second IVB at the 3-week follow-up. In these eyes, the mean preoperative and 3-month mean CMT were 413.73 and 377, respectively. The risk factors for poor visual outcome were, male gender [odds ratio (OR) 3.333], poor preoperative visual acuity (OR 8.42) and posterior capsular dehiscence (OR 5.1). Conclusions: Phacoemulsification with IVB injection improved the visual acuity at 3 weeks and 3 months but the mean CMT increased at 3 weeks and a decreased at 3 months only after the second IVB injection. Poor presenting visual acuity was an independent risk factor for poor visual outcome.