Diabetics have a high chance of developing cataracts at early ages. Uncontrolled diabetics have further high chances. There are many precautions to be taken before going for surgery in such cases. First and foremost is strict diabetic control. The random blood sugar levels are very important as sometimes the fasting level is controlled but random blood sugar fluctuates to high levels. This needs further clearance from a diabetologist/endocrinologist. Hb A, C is an important indicator of control of blood sugar. This is the value of three-month control. It is important that this value is in control before going for cataract surgery. Fluctuation of blood sugar levels further decreases the prognosis after cataract surgery.
Fundus evaluation before cataract surgery is also important in the case of patients with diabetes. The changes in the retina should be well documented before going in for surgery. It is also important medico-legally because the vision after cataract surgery depends on the condition of the retina. Retina should be examined and preferably OCT (Optical Coherence Tomography) be done before cataract surgery. A B-ultrasound scan needs to be done if the retina is not visible.
When the patient is going in for cataract surgery proper hygiene has to be maintained as diabetics are more prone to develop infections. Hair washes before surgery is beneficial. Preferably the patient should undergo stitch-less phacoemulsification. The smaller the incision size better it is. The 2.2 phacoemulsification is desirable and selection of IOL (Lens) is also important. Avoid multifocal lens and a good unifocal lens need to be implanted. Toric/ Unifocal lenses can be chosen for surgery. All aseptic precautions need to be taken before and after surgery.
Cleansing of the eye after eye surgery needs to be meticulous and the use of cotton needs to be avoided. If there is any evidence of diabetic retinopathy, Infection of Antiveg F can be done concurrently with cataract surgery. The laser can be postponed after surgery but treatment has to be completed after cataract surgery.
Remember ‘Cataract surgery is the first step in treatment and not the only treatment in Diabetes’.