Long-term outcomes of anti-VEGF therapy during cataract surgery in eyes with diabetic macular edema: a five-year retrospective cohort study

To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy during cataract surgery in eyes with diabetic macular edema (DME).

This was a retrospective clinical study. Patients with DME scheduled for cataract surgery were included. Prior to surgery, DME was considered adequately controlled, defined as a central subfield thickness (CST) of ≤300 μm without evidence of significant intraretinal or subretinal fluid on optical coherence tomography. Participants were divided into two groups: 18 patients underwent cataract surgery alone, and 10 received both cataract surgery and anti-VEGF therapy concurrently. The study compared the timing of the initial postoperative anti-VEGF injection and the frequency of injections over 5y. Postoperative outcomes, particularly improvements in best-corrected visual acuity (BCVA) and changes in CST, were also examined.

A total of 28 patients were enrolled, with 10 patients undergoing combined cataract surgery and anti-VEGF therapy (3 males, 62.8±4.4y), while 18 patients (7 males, 70.0±13.6y) underwent cataract surgery alone. The combined therapy group had a significantly longer interval before the initial postoperative anti-VEGF injection (12.2±5.7wk) compared to the cataract-only group (4.4±1.6wk). The combined therapy group also required significantly fewer total anti-VEGF injections over 1, 3, and 5y, with the most notable difference in the first year. There was significant improvement in BCVA from pre- to postoperative stages across all eyes. However, there was no statistically significant difference in postoperative BCVA and CST between the groups.

Concurrent anti-VEGF therapy during cataract surgery is associated with lower early postoperative DME recurrence and a longer interval to the first postoperative anti-VEGF injection. This combined approach may reduce early treatment burden.