Review on the Influence of Diabetes Mellitus in the Visual Prognosis of Cataract Surgery

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Ragni Kumari
Salai Dhavamathi Janarthanan
Mrinal Ranjan Srivastava
Pragati Garg
Rajiv Janardhanan


India is deliberated the diabetes hub of the world, and a substantial amount of patients undergoing cataract surgery are diabetic. Developments in surgical techniques and instrumentation of cataract have large enriched the outcomes; but, surgical procedure may not be benign and real in certain entities with pre-existing retinal pathology or inadequate visual potential.. Keeping this in mind, we surveyed the different layers of the eye in managing the cataract in patients with diabetes. The changes in the cornea, intra ocular lens, choroid, and retina are the factors which influenced the visual prognosis of diabetic cataract patients. Better comprehension of different elements in charge of good result of cataract surgery in diabetic patients may direct us in better options in the management of these patients and advancing the outcomes. This review article targets to address diverse features adjoining cataracts in diabetic patients. In anelectronic MEDLINE search, appropriate studies were selected by authors using the relevant keywords.

Cataract, diabetes, eye, visual outcome, health, prognosis.

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How to Cite
Kumari, R., Dhavamathi Janarthanan, S., Ranjan Srivastava, M., Garg, P., & Janardhanan, R. (2020). Review on the Influence of Diabetes Mellitus in the Visual Prognosis of Cataract Surgery. Ophthalmology Research: An International Journal, 11(4), 1-8.
Review Article


Wild S, Roglic G, Green a, Sicree R, King H. Global prevalenceof diabetes: Estimates for the year 2000 and projections for 2030.Diabetes Care. 2004; 27:1047-3.

Prevention of blindness from diabetic retinopathy. Report of aWHO Consultation, Geneva; November; 2005.

Guidelines for the Comprehensive Management of Diabetic Retinopathy in India. A vision 2020 the Right to Sight IndiaPublication; 2008.

Gadkari SS, Maskati QB, Nayak BK. Prevalence ofdiabetic retinopathy in India: The All India Ophthalmological Society DiabeticRetinopathyEye Screening Study 2014. Indian J Ophthalmol. 2016;64:38-44.

Raman R, Rani PK, ReddiRachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, et al. Prevalence of diabetic retinopathy inIndia: Sankara Nethralaya diabetic retinopathy epidemiology andmolecular genetics study report 2. Ophthalmology. 2009;116:311‑8.

Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: The Chennaiurban Rural Epidemiology Study (CURES) eye study, I. Invest Ophthalmol Vis Sci. 2005;46:2328‑33.

Namperumalsamy P, Kim R, Vignesh TP, Nithya N, RoyesJ,Gijo T, et al. Prevalence and risk factors for diabetic retinopathy:A population‑based assessment from Theni District, South India. Postgrad Med J 2009;85:643-8.

Narendran V, John RK, Raghuram A, Ravindran RD, Nirmalan PK,Thulasiraj RD. Diabetic retinopathy among self- reported diabetics in Southern India: A population based assessment. Br J Ophthalmol. 2002;86:1014‑8.

Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Rao GN. Population based assessment of diabetic retinopathy in an urbanpopulation in Southern India. Br J Ophthalmol 1999;83:937‑40.

Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Riskfactors for diabetic retinopathy in a South Indian type 2diabetic population – The Chennai urban rural epidemiologystudy (CURES) eye study 4. Diabet Med. 2008;25:536‑42.

Lian JX, Gangwani RA, McGhee SM, Chan CK, Lam CL, et al.Primary Health Care Group,. Systematic screening for diabeticretinopathy (DR) in Hong Kong: Prevalence of DR and visualimpairment among diabetic population. Br J Ophthalmol. Bjophthalmol. 2015;307382.

Rodriguez‑Poncelas A, Miravet‑Jiménez S, CasellasA,Barrot‑De La Puente JF, Franch‑Nadal J, López‑Simarro F, et al. Prevalence of diabetic retinopathy in individuals with type 2diabetes who had recorded diabetic retinopathy from retinalphotographs in Catalonia (Spain). Br J Ophthalmol. 2015;99:1628-33.

Dawkins RC, Oliver GF, Sharma M, Pinto BM, JeronimoB,Pereira B, et al. An estimation of the prevalence of diabetes mellitusand diabetic retinopathy in adults in Timor‑Leste. BMC Res Notes. 2015;8:249.

Huang OS, Tay WT, Ong PG, Sabanayagam C, Cheng CY, Tan GS, et al. Prevalence and determinants of undiagnosed diabeticretinopathy and vision‑threatening retinopathy in a multiethnicAsian cohort: The Singapore epidemiology of eye diseases (SEED)study. Br J Ophthalmol. 2015; 99:1614‑21.

Giloyan A, Harutyunyan T, Petrosyan V. The prevalence ofand major risk factors associated with diabetic retinopathy inGegharkunik province of Armenia: Cross‑sectional study. BMCO phthalmol 2015;15:46.

Dutra Medeiros M, Mesquita E, Papoila AL, Genro V, Raposo JF. First diabetic retinopathy prevalence study in Portugal: Retinodiab study – Evaluation of the screeningprogramme for Lisbon and Tagus Valley region. Br J Ophthalmol. 2015;99:1328‑33.

Hajar S, Al Hazmi A, Wasli M, Mousa A, Rabiu M. Prevalence andcauses of blindness and diabetic retinopathy in Southern SaudiArabia. Saudi Med J. 2015; 36:449‑55.

Hykin PG, et al. Extracapsular cataract extraction in proliferative diabetic retinopathy. Ophthalmology. 1993;100: 394–399,

Chew EY, et al. Results after lens extractionin patients with diabetic retinopathy: Early treatment diabetic retinopathy study report number 25. Arch Ophthalmol. 1999;117:1600–1606.

Cohen SM, et al. Endophthalmitis After Pars Plana vitrectomy: the Postvitrectomy Endophthalmitis Study. Opthalmology. 1995;102:705–712.

Kattan HM, et al: Nosocomial endopthalmitis survey: Current injcidence of infection after intraocular-surgery. Ophthalmology. 1991;98:227–238.

Montan PG, et al: Endophthalmitis Cataract surgery: RISK factors relating totechnique and events of the operationand patient history. Ophthalmo-logy. 1998;105:2171–2177.

Scott IU, Flynn HWJ, Feuer W: Endopthalmitis after secondary intraocular lens implantation: A case-control study. Ophthalmology.1995;102:1925–1931.

Doft BH, et al. Diabetes and post cataract extraction endophthalmitis. Curr Opin Ophthalmol. 2002;13:147–151.

Zhivov A, Winter K, Hovakimyan M, et al. Imaging and quantification of subbasal nerve plexus in healthy volunteersand diabetic patients with or without retinopathy. PLoS One. 2013;8:e52157.

He J, Bazan HE. Mapping the nerve architecture of diabetichuman corneas. Ophthalmology. 2012;119:956–964.

Midena E, Brugin E, Ghirlando A, Sommavilla M, AvogaroA.Corneal diabetic neuropathy: A confocal microscopy study. JRefract Surg. 2006;22:S1047–S1052.

Midena E, Cortez M, Miotto S, Gambato C, Cavarzeran F, Ghirlando A. Confocal microscopy of corneal sub-basal nerveplexus: A quantitative and qualitative analysis in healthy andpathologic eyes. J Refract Surg. 2009;25:S125–S130.

Kabosova A, Kramerov AA, Aoki AM, Murphy G, Zieske JD, Ljubimov AV. Human diabetic corneas preserve wound healing, basement membrane, integrin and MMP-10 differences fromnormal corneas in organ culture. Exp Eye Res. 2003; 77:211–217.

Saghizadeh M, Kramerov AA, Yaghoobzadeh Y, et al. Adenovirus driven overexpression of proteinases in organ-cultured normalhuman corneas leads to diabetic-like changes. Brain Res Bull. 2010;81:262–272.

Saghizadeh M, Kramerov AA, Yu FS, Castro MG, Ljubimov AV. Normalization of wound healing and diabetic markers in organcultured human diabetic corneas by adenoviral delivery of c-Metgene. Invest Ophthalmol Vis Sci. 2010;51:1970–1980.

Rowe NG, et al: Diabetes, fasting blood glucose and age-related cataract: theBlue Mountains Eye Study. Ophthalmic Epidemiol. 2000;7:103–114.

Hiller R, Sperduto RD, Ederer F: Epidemiologic associations with nuclear, cortical, and posterior subcapsular cataracts. Am J Epidemiol. 1986;124:916–925.

Miglior S, et al. Risk factors for cortical, nuclear, posterior subcapsular and mixedcataract: A case-control study. OphthalmicEpidemiol. 1994;1:93–105.

Delcourt C, et al. Risk factors for cortical, nuclear, and posterior subcapsular cataract: The POLA study: Pathologies Oculaires Lieesal’ Age. Am J Epidemiol. 2000;151:497–504.

Klein BE, et al. Older-onset diabetes andlens opacities: the Beaver Dam Eye Study. Ophthalmic Epidemiol. 2005;2:49 –55.

Saxena S, Mitchell P, Rochtchina E: Five Year Incidence of cataract in older persons with diabetes and pre-diabetes. Ophthalmic Epidemiol. 2004;11:271–277.

McCarty CA, et al. Risk factors for age related maculopathy: the Visual Impairment Project. Arch Ophthalmol. 2001;19:1455–1462.

Mukesh BN, et al: Development of cataract and associated risk factors: The Visual Impairment Project. Arch Ophthalmol., 2006;124:79–85.

Leske MC, Chylack LT Jr, Wu SY: TheLens Opacities Case-Control Study: riskfactors for cataract. Arch Ophthalmol. 1991;109:244–251.

Hennis A, et al. Risk factors for incidentcortical and posterior subcapsular lensopacities in the Barbados Eye Studies. Arch Ophthalmol. 2004;122:525–530.

Foster PJ, et al. Risk factors for nuclear, cortical and posterior subcapsular cataractsin the Chinese population of Singapore: The TanjongPagar Survey. Br J Ophthalmol. 2003;87:1112–1120.

Tsai SY, et al. Epidemiologic study ofage-related cataracts among an elderlyChinese population in Shih-Pai, Taiwan. Ophthalmology. 2003;110:1089–1095.

Nirmalan PK, et al. Risk factors for agerelated cataract in a rural population ofsouthern India: the Aravind comprehensive eye study. Br J Ophthalmol. 2004;88:989–994.

Leske MC, et al. Diabetes, hypertension, and central obesity as cataract risk factorsin a black population: the Barbados Eye Study. Ophthalmology.1999;106:35– 41.

Harding JJ, et al. Diabetes, glaucoma, sex, and cataract: analysis of combined data from two case control studies. Br JOphthalmol. 1993;77:2– 6.

Bron AJ, et al: The lens in diabetes. Eye. 1993;7:260 –275.

Klein BE, Klein R, Lee KE: Diabetes, cardiovascular disease, selected cardiovascular disease risk factors, and the 5-yearincidence of age-related cataract andprogression of lens opacities: the BeaverDam Eye Study. Am J Ophthalmol., 1998;126:782–790.

Kato S, et al. Glycemic control and lenstransparency in patients with type 1 diabetesmellitus. Am J Ophthalmol. 2001; 131:301-304.

Klein BE, Klein R, Moss SE: Incidence ofcataract surgery in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Am J Ophthalmol. 1995;119: 295–300.

Negahban K, Chern K: Cataracts associated with systemic disorders and syndromes. Curr Opin Ophthalmol. 2002; 13:419-422.

Pirie A: Epidemiological and biochemical studies of cataract and diabetes. Invest Ophthalmol. 1965;4:629–637.

Murtha T, Cavallerano J: The management of diabetic eye disease in the settingof cataract surgery. Curr Opin Ophthalmol. 2007;18:13–18.

Adamis AP. Is diabetic retinopathy an inflammatory disease? Br J Ophthalmol. 2002;86:363–365.

Kern TS. Contributions of inflammatory processes to the development of the early stages of diabetic retinopathy. Exp Diabetes Res. 2007;95103.

Noda K, Nakao S, Ishida S, Ishibashi T. Leukocyte adhesion molecules in diabetic retinopathy. J Ophthalmol. 2012;279037.

Clausell N, Kalil P, Biolo A, Molossi S, Azevedo M. Increased expression of tumor necrosis factor-alpha in diabetic macrovasculopathy. Cardiovasc Pathol. 1999;8:145–151.

Clausen P, Jacobsen P, Rossing K, Jensen JS, Parving HH, Feldt-Rasmussen B. Plasma concentrations of VCAM-1 and ICAM-1 areelevated in patients with Type 1 diabetes mellitus with microalbinuria and overt nephropathy. Diabet Med. 2000; 17:644–649.

Wierusz-Wysocki B, Wysocki H, Siekierka H, Wykretowicz A, Szcaepanik A, Klimas R. Evidence of polymorphonuclear neutrophils (PMN) activation in patients with insulin- dependent diabetes mellitus. J Leukoc Biol. 1987;42:519–523.

Characteristics of patients with nonarteriticanterior ischemic optic neuropathyeligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol. 1996;114:1366–1374.

Flammer J, et al: The impact of ocularblood flow in glaucoma. Prog Ret Eye Res. 2002;21:359–393.

Piltz-Seymour JR, et al. Optic nerve blood flow is diminished in eyes of primaryopen-angle glaucoma suspects. Am J Ophthalmol. 2001;132:63– 69.

Hayreh SS, et al. Nonarteritic anterior ischemic optic neuropathy: Role of nocturnal arterial hypotension. Arch Ophthalmol. 1997;115:942–945.

Arnold AC: Pathogenesis of nonarteriticanterior ischemic optic neuropathy. J Neuro Ophthalmol. 2003;23:157–163.

Optic nerve decompression surgery fornonarteritic anterior ischemic optic neuropathy (NAION) is not effective andmay be harmful: The Ischemic Optic Neuropathy Decompression Trial Research Group. JAMA. 1995;273:625–632.

Yoles E, Wheeler LA, Schwartz M: Alpha2-adrenoreceptor agonists are neuroprotectivein a rat model of optic nervedegeneration. Invest Ophthalmol Vis Sci. 1999;40:65–73.

Kupersmith MJ, et al. Aspirin reducesthe incidence of second eye NAION: aretrospective study. J Neuroophthalmol. 1997;17:250 –253.

Barr CC, Glaser JS, Blankenship G:Acute disc swelling in juvenile diabetes:clinical profile and natural history of 12cases. Arch Ophthalmol. 1980;98:2185–2192.

Bandello F, Menchini F: Diabetic papillopathyas a risk factor for progression ofdiabetic retinopathy. Retina. 2004;24: 183–184.

Sato T, et al: Development of bilateral, nonarteritic anterior ischemic optic neuropathyin an eye with diabetic papillopathy. Jpn J Ophthalmol. 2004;48: 158 –162.

Hayreh SS, Zahoruk RM: Anterior ischemicoptic neuropathy. VI. In juvenile diabetes. Ophthalmologica. 1981;182:13–28

Friedrich Y, et al. Diabetic papillopathy with macular star mimicking clinicallysignificant diabetic macular edema. Retina. 2001;21: 80–82.

Pavan PR, et al. Optic disc edema in juvenile-onset diabetes. Arch Ophthalmol. 1980;98:2193–5219.

Al-Haddad CE, Jurdi FA, Bashshur ZF. Intravitreal triamcinolone acetonideforthe management of diabetic papillopathy. Am J Ophthalmol. 2004;137:1151–1153.

Eshbaugh CG, et al. Simultaneous, multiplecranial neuropathies in diabetes mellitus. J Neuroophthalmol.1995;15:219–224.

Singh NP, et al. Multiple cranial nervepalsies associated with type 2 diabetesmellitus. Singapore Med J. 2006;47:712–715.

Rush JA: Extraocular muscle palsies indiabetes mellitus. Int Ophthalmol Clin. 1984;24:155–159.

Watanabe K, et al. Characteristics of cranialnerve palsies in diabetic patients. Diabetes Res ClinPract. 1990;10:19 –27.