Incidence Of Cystoid Macular Oedema In Diabetic Patients Undergoing Phacoemulsification Surgery And Receiving Post-Operative Topical Ketorolac And Steroids

Diabetes increases the risk of developing cataract and post-operative cystoid macular oedema (CMO). There has been an increasing interest in the optimum protocol for the prevention of CMO after cataract surgery. Recent literature has shown that a combination of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of cystoid macular oedema. Our study evaluated the efficacy of a preventative protocol (combination of topical Ketorolac and steroids) used on all diabetic patients undergoing cataract surgery.

A single tertiary centre in the United Kingdom, where all diabetic patients undergoing cataract surgery receive Acular (ketorolac trometamol 0.5%) three times a day for 21 days postoperatively as well as steroid eyes drops four times a day for 28 days.  Multiple senior cataract surgeons as well as supervised residents undertook the operations. All patients were examined post-operatively at the same unit.

Retrospective analysis of all adult diabetic patients who underwent uncomplicated phacoemulsification and lens implant between January 2020 and December 2024. Data was collected from electronic patient records. Patient demographics, the presence of pre-existing diabetic macular oedema, the development of CMO following the surgery and subsequent treatment were recorded.

A total of 15963 cataract operations were performed between January 2020 and December 2024, of which 3494 patients had diabetes and received combination topical therapy post operatively as described above. 25 patients (0.72%) with diabetes who underwent cataract surgery and received combination topical therapy were found to have post-operative CMO. 13 patients (0.37%) developed new onset CMO and 12 patients had pre-existing diabetic macular oedema which worsened post-operatively (0.34%).

We report low incidence of new onset CMO in a large cohort of diabetic patients undergoing cataract surgery receiving combination topical therapy post-operatively (0.37%). The PREMED 1 study detected CMO in 1.5% of non-diabetic patients receiving combination therapy (topical NSAIDs and steroids). This risk is known to be higher in diabetic patients, various studies quoting an incidence between 4 to 7%. Not all patients in our study underwent macular optical coherence tomography, however we found Acular in combination with steroid eye drops was effective at preventing post-operative CMO in our large cohort of diabetic patients. Our study justifies our continued use of post-operative Acular in diabetic patients undergoing cataract surgery.