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The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema
  1. Alastair K Denniston1,2,
  2. Usha Chakravarthy3,
  3. Haogang Zhu4,
  4. Aaron Y Lee5,
  5. David P Crabb4,
  6. Adnan Tufail2,
  7. Clare Bailey6,
  8. Toks Akerele7,
  9. Sahar Al-Husainy8,
  10. Christopher Brand9,
  11. Louise Downey10,
  12. Alan Fitt11,
  13. Rehna Khan12,
  14. Vineeth Kumar13,
  15. Aires Lobo14,
  16. Sajjad Mahmood15,
  17. Kaveri Mandal16,
  18. Martin Mckibbin17,
  19. Geeta Menon18,
  20. Salim Natha19,
  21. Jong Min Ong20,
  22. Marie D Tsaloumas1,
  23. Atul Varma21,
  24. Elizabeth Wilkinson22,
  25. Robert L Johnston23,
  26. Catherine A Egan2
  27. on behalf of the UK DR EMR Users Group
  1. 1 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHSFT and UCL Institute for Ophthalmology, London, UK
  3. 3 Centre for Experimental Medicine, Queens University, Belfast, UK
  4. 4 City University, London, UK
  5. 5 Department of Ophthalmology, University of Washington, Seattle, USA
  6. 6 Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  7. 7 Department of Ophthalmology, Hinchingbrooke Health Care NHS Trust, Huntingdon, UK
  8. 8 Department of Ophthalmology, Heart of England NHS Foundation Trust, Birmingham, UK
  9. 9 Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  10. 10 Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
  11. 11 Department of Ophthalmology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
  12. 12 Department of Ophthalmology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
  13. 13 Department of Ophthalmology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
  14. 14 Moorfields Eye Unit, Bedford Hospitals NHS Trust, Bedford, UK
  15. 15 Manchester Royal Eye Hospital, Manchester, UK
  16. 16 Department of Ophthalmology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK
  17. 17 Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  18. 18 Department of Ophthalmology, Frimley Park Hospital, Frimley, UK
  19. 19 Department of Ophthalmology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
  20. 20 Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  21. 21 Department of Ophthalmology, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
  22. 22 Department of Ophthalmology, Northern Devon Healthcare NHS Trust, Barnstaple, UK
  23. 23 Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
  1. Correspondence to Catherine A Egan, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK; Catherine.Egan{at}moorfields.nhs.uk

Abstract

Aim To assess the rate of ‘treatment-requiring diabetic macular oedema (DMO)’ in eyes for the two  years before and after cataract surgery.

Methods Multicentre national diabetic retinopathy (DR) database study with anonymised data extraction across 19 centres from an electronic medical record system. Inclusion criteria: eyes undergoing cataract surgery in patients with diabetes with no history of DMO prior to study start. The minimum dataset included: age, visual acuity (all time-points), injection episodes, timing of cataract surgery and ETDRS grading of retinopathy and maculopathy. Main outcome measure: rate of developing first episode of treatment-requiring DMO in relation to timing of cataract surgery in the same eye.

Results 4850 eyes met the inclusion criteria. The rate of developing treatment-requiring DMO in this cohort was 2.9% in the year prior to surgery versus 5.3% in the year after surgery (p<0.01). The risk of ‘treatment-requiring DMO’ increased sharply after surgery, peaking in the 3–6 months' period (annualised rates of 5.2%, 6.8%, 5.6% and 4.0% for the 0–3, 3–6, 6–9 and 9–12 months' post-operative time periods respectively). Risk was associated with pre-operative grade of retinopathy: risk of DMO in the first year post-operatively being 1.0% (no DR pre-operatively), 5.4% (mild non-proliferative diabetic retinopathy; NPDR), 10.0% (moderate NPDR), 13.1% (severe NPDR) and 4.9% (PDR) (p<0.01).

Conclusions This large real-world study demonstrates that the rate of developing treatment-requiring DMO increases sharply in the year after cataract surgery for all grades of retinopathy, peaking in the 3–6 months' postoperative period. Patients with moderate and severe NPDR are at particularly high risk.

  • Diabetic macular oedema
  • Diabetic retinopathy
  • Cataract
  • Electronic medical record
  • Intravitreal therapy
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Footnotes

  • Contributors All the authors have contributed to the planning, conduct and reporting of the work described in the article.

  • Competing interests RLJ is the Medical Director of Medisoft Limited, the Electronic Medical Record software provider from which data were extracted.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data have been published within this article and the accompanying manuscripts.

  • Collaborators The full list of authors and affilliations comprising the UK DR EMR Users Group is provided in Appendix 1.

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