3. CATARACT SUEGRY AND DIABETES

4. Indications of surgery: 1) Visual loss 2)Surveillance of retinopathy 3)Laser therapy

5. PREOPERATIVE CONSIDERATIONS :  VA  Slitlamp Exam  Fundoscopy  Sonography

6. SURGICAL TECHNIQUE:  Phaco.  Large Capsulorrhexis  Large Optic Diameter Lenses  Acrylic Lenses

7. POST OPERATIVE MANAGEMENT: 1.Steroids 2.NSAID 3.Close Post Operative Fundocopy

8. Decreased vision after surgery by: - Severe fibrinous uveitis - Capsular opacity - NVI - Macular edema - Deterioration of retinopathy

9. Cataract surgery and progression of diabetic retinal disease Jaffe et al (1992): Nonproliferative diabetic retinopathy progressed following ECCE

10. Romero-Aroca et al.(2006): no significant differences in the rates of diabetic retinopathy progression with and without cataract surgery

11. cataract surgery causes progression of diabetic macular edema Biro´ and Balla (2009): Increased macular thickening in the first 2 months after surgery, with no significant difference between diabetics and normal controls

12. As a whole, there is no clear evidence that phacoemulsification surgery causes progression of diabetic retinopathy or diabetic macular edema, particularly in patients with low-risk or absent diabetic retinopathy

13. PERI-OPERATIVE TRIAMCINOLONE Kim et al. (2008): They found no significant difference in diabetic retinopathy progression, visual acuities, or central macular thickness at 6 months postoperatively

14. INTRAVITREAL TRIAMCINOLONE No long-term benefit of in comparison with focal/grid photocoagulation in eyes with diabetic macular edema

15. INTRAVITREAL BEVACIZUMAB AFTER CATARACT SURGERY The study makes no comment on any differences in acuity improvement between the treated and untreated groups

16. PANRETINAL PHOTOCOAGULATION AND CATARACT SURGERY TIMING The PRP-first group had significantly higher levels of aqueous flare intensity that persisted until 3 months post phacoemu- lsification

17. PRP-first with higher aqueous flare intensities,worse visual outcomes and macular edema progression

18. CONCLUSION: adjuvant anti-inflammatory or anti-VEGF agents at the time of cataract surgery show improved outcomes of acuity and macular edema primarily in patients with preexisting macular edema at the time of surgery

19. CATARACT SURGERY AND GLAUCOMA

20. CATARACT SURGERY IN ANGLE CLOSURE GLAUCOMA UBM and anterior segment OCT have recently confirmed that a thickened and anteriorly positioned lens may be involved in the pathogenesis of PACG

21. Plateau iris mechanisms can comprise up to 62% of eyes with anatomically narrow angles in some populations

22. These findings suggest that lens extraction may be advantageous in eyes with PACG and may lead to a significant IOP reduction

23. CATARACT SURGERY IN OPEN ANGLE GLAUCOMA Cataract surgery Trabeculectomy Cataract extraction and trabeculectomy Alternative surgical technique to lower IOP

24. severity of glaucoma visual needs Experience and skill of the surgeon

25. CATARACT SURGERY ALONE Glaucomatous damage is mild IOP is within the target range well tolerated medications

26. TRABECULECTOMY ALONE Patients with uncontrolled severe glaucoma despite maximum tolerable medical therapy should benefit from trabeculectomy alone

27. COMBINED CATARACT SURGERY AND TRABECULECTOMY In the presence of a visually significant cataract and uncontrolled glaucoma

28. CONCLUSION: important factors 1.Age 2. Disease Severity 3.Ability To Tolerate Medications 4.Desired IOP

29. THE END