Influence of Uncomplicated Phacoemulsification on Central Macular Thickness in Diabetic Patients: A Meta-Analysis

Objective To evaluate the effect of uncomplicated phacoemulsification on central macular thickness (CMT) and best corrected visual acuity (BCVA) in both diabetic patients without diabetic retinopathy (DR) and diabetic patients with mild to moderate non-proliferative diabetic retinopathy (NPDR). Methods Potential prospective observational studies were searched through PubMed and EMBASE. Standardized mean difference (SMD) and 95% confidence interval (CI) for changes in CMT and BCVA were evaluated at postoperative 1, 3 and 6 months. The pooled effect estimates were calculated in the use of a random-effects model. Results A total of 10 studies involving 190 eyes of diabetic patients without diabetic retinopathy and 143 eyes of diabetic patients with NPDR were identified. CMT values demonstrated a statistically significant increase after uncomplicated phacoemulsification at 1 month (SMD, -0.814; 95% CI, -1.230 to -0.399), 3 months (SMD, -0.565; 95% CI, -0.927 to -0.202) and 6 months (SMD, -0.458; 95% CI, -0.739 to -0.177) in diabetic patients with NPDR. There was no statistical difference in CMT values at postoperative 1 month (SMD, -1.206; 95% CI, -2.433 to 0.021) and no statistically significant increase in CMT values at postoperative3 months (SMD, -0.535; 95% CI, -1.252 to 0.182) and 6 months (SMD, -1.181; 95% CI, -2.625 to 0.263) in diabetic patients without DR. BCVA was significantly increased at postoperative 1 month (SMD, 1.149; 95% CI, 0.251 to 2.047; and SMD, 1.349; 95% CI, 0.264 to 2.434, respectively) and 6 months (SMD, 1.295; 95% CI, 0.494 to 2.096; and SMD, 2.146; 95% CI, 0.172 to 4.120, respectively) in both diabetic patients without DR and diabetic patients with NPDR. Sensitivity analysis showed that the results were relatively stable and reliable. Conclusion Uncomplicated phacoemulsification in diabetic patients with mild to moderate NPDR seemed to influence significantly the subclinical thickening of the macular zones at postoperative 1, 3 and 6 months compared with diabetic patients without DR. BCVA was significantly improved in both diabetic patients without DR and diabetic patients with mild to moderate NPDR.