Results After Lens Extraction in Patients With Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study Report Number 25
OBJECTIVE To assess the visual results after surgical lens removal in patients with diabetic retinopathy. DESIGN A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic reti...
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| Veröffentlicht in: | Archives of ophthalmology (1960) 1999-12, Vol.117 (12), p.1600-1606 |
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| creator | Chew, Emily Y Benson, William E Remaley, Nancy A Lindley, Anna A Burton, Thomas C Csaky, Karl Williams, George A Ferris, Frederick L |
| description | OBJECTIVE To assess the visual results after surgical lens removal in patients with diabetic retinopathy. DESIGN A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema. PARTICIPANTS Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years. OUTCOME MEASUREMENTS Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed. RESULTS The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adj |
| doi_str_mv | 10.1001/archopht.117.12.1600 |
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DESIGN A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema. PARTICIPANTS Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years. OUTCOME MEASUREMENTS Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed. RESULTS The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adjusted analyses (P=.03). No statistically significant long-term increased risk of macular edema was documented after lens surgery. CONCLUSIONS Visual acuity results after lens surgery in patients in the Early Treatment Diabetic Retinopathy Study were better than published results for similar patients. This may be because of more intensive photocoagulation for lesions of diabetic retinopathy in the Early Treatment Diabetic Retinopathy Study than in previously reported studies. Although patients with severe nonproliferative retinopathy or worse before lens surgery had poorer visual results, visual improvement was seen in 55% of these patients at 1-year follow-up. The main causes of poor visual results in eyes after lens surgery were complications of proliferative retinopathy and/or macular edema.Arch Ophthalmol. 1999;117:1600-1606--></description><identifier>ISSN: 0003-9950</identifier><identifier>ISSN: 2168-6165</identifier><identifier>EISSN: 1538-3601</identifier><identifier>EISSN: 2168-6173</identifier><identifier>DOI: 10.1001/archopht.117.12.1600</identifier><identifier>PMID: 10604663</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aspirin - therapeutic use ; Biological and medical sciences ; Cataract - complications ; Cataract - physiopathology ; Cataract - therapy ; Cataract Extraction ; Diabetic Retinopathy - complications ; Diabetic Retinopathy - physiopathology ; Diabetic Retinopathy - therapy ; Disease Progression ; Female ; Humans ; Laser Coagulation ; Macular Edema - complications ; Macular Edema - physiopathology ; Macular Edema - therapy ; Male ; Medical sciences ; Middle Aged ; Postoperative Complications ; Prognosis ; Prospective Studies ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the eye and orbit ; Visual Acuity</subject><ispartof>Archives of ophthalmology (1960), 1999-12, Vol.117 (12), p.1600-1606</ispartof><rights>2000 INIST-CNRS</rights><rights>Copyright American Medical Association Dec 1999</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1253824$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10604663$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chew, Emily Y</creatorcontrib><creatorcontrib>Benson, William E</creatorcontrib><creatorcontrib>Remaley, Nancy A</creatorcontrib><creatorcontrib>Lindley, Anna A</creatorcontrib><creatorcontrib>Burton, Thomas C</creatorcontrib><creatorcontrib>Csaky, Karl</creatorcontrib><creatorcontrib>Williams, George A</creatorcontrib><creatorcontrib>Ferris, Frederick L</creatorcontrib><title>Results After Lens Extraction in Patients With Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study Report Number 25</title><title>Archives of ophthalmology (1960)</title><addtitle>Arch Ophthalmol</addtitle><description>OBJECTIVE To assess the visual results after surgical lens removal in patients with diabetic retinopathy. DESIGN A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema. PARTICIPANTS Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years. OUTCOME MEASUREMENTS Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed. RESULTS The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adjusted analyses (P=.03). No statistically significant long-term increased risk of macular edema was documented after lens surgery. CONCLUSIONS Visual acuity results after lens surgery in patients in the Early Treatment Diabetic Retinopathy Study were better than published results for similar patients. This may be because of more intensive photocoagulation for lesions of diabetic retinopathy in the Early Treatment Diabetic Retinopathy Study than in previously reported studies. Although patients with severe nonproliferative retinopathy or worse before lens surgery had poorer visual results, visual improvement was seen in 55% of these patients at 1-year follow-up. The main causes of poor visual results in eyes after lens surgery were complications of proliferative retinopathy and/or macular edema.Arch Ophthalmol. 1999;117:1600-1606--></description><subject>Aspirin - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cataract - complications</subject><subject>Cataract - physiopathology</subject><subject>Cataract - therapy</subject><subject>Cataract Extraction</subject><subject>Diabetic Retinopathy - complications</subject><subject>Diabetic Retinopathy - physiopathology</subject><subject>Diabetic Retinopathy - therapy</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Humans</subject><subject>Laser Coagulation</subject><subject>Macular Edema - complications</subject><subject>Macular Edema - physiopathology</subject><subject>Macular Edema - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the eye and orbit</subject><subject>Visual Acuity</subject><issn>0003-9950</issn><issn>2168-6165</issn><issn>1538-3601</issn><issn>2168-6173</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0VtrFDEUB_BQlHat_QCCSBDxbdZzkklmx7dS1wssVXrBx3BmJsOmzM0kA-6bH92UXa1IXxKS_M5JyJ-xlwhLBMB35OvtOG3jErFYoliiBjhiC1RylUkN-IQtAEBmZanghD0L4S4tNUJ5zE4QNORaywX7dWXD3MXAz9toPd_YIfD1z-ipjm4cuBv4N4rODkl8d3HLPziqbHQ1v0rjME4Ut7v3fE2-2_Ebbyn2yT6q-HWcm13amUYf-eXcV-k-oZ6zpy11wZ4d5lN2-3F9c_E523z99OXifJORFDpmBSqNFVat1CtJAiAvVI6NBLXKNRGAFU0tG9S6EC2ibvKyKKAqMJW0q4rkKXu77zv58cdsQzS9C7XtOhrsOAejS6lKLWWCr_-Dd-Psh_Q2IySmzyxAJZTvUe3HELxtzeRdT35nEMx9POZPPCbFY1CY-3hS2atD77nqbfNP0T6PBN4cAIWautbTULvw4ERKV-SJvdgz6unvYY5CK5S_AW0TofE</recordid><startdate>19991201</startdate><enddate>19991201</enddate><creator>Chew, Emily Y</creator><creator>Benson, William E</creator><creator>Remaley, Nancy A</creator><creator>Lindley, Anna A</creator><creator>Burton, Thomas C</creator><creator>Csaky, Karl</creator><creator>Williams, George A</creator><creator>Ferris, Frederick L</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>19991201</creationdate><title>Results After Lens Extraction in Patients With Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study Report Number 25</title><author>Chew, Emily Y ; Benson, William E ; Remaley, Nancy A ; Lindley, Anna A ; Burton, Thomas C ; Csaky, Karl ; Williams, George A ; Ferris, Frederick L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a326t-71561b1bf3683a20047541d305846aa00e2dc3d16672f116d49770b711bff8ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aspirin - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cataract - complications</topic><topic>Cataract - physiopathology</topic><topic>Cataract - therapy</topic><topic>Cataract Extraction</topic><topic>Diabetic Retinopathy - complications</topic><topic>Diabetic Retinopathy - physiopathology</topic><topic>Diabetic Retinopathy - therapy</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Humans</topic><topic>Laser Coagulation</topic><topic>Macular Edema - complications</topic><topic>Macular Edema - physiopathology</topic><topic>Macular Edema - therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the eye and orbit</topic><topic>Visual Acuity</topic><toplevel>online_resources</toplevel><creatorcontrib>Chew, Emily Y</creatorcontrib><creatorcontrib>Benson, William E</creatorcontrib><creatorcontrib>Remaley, Nancy A</creatorcontrib><creatorcontrib>Lindley, Anna A</creatorcontrib><creatorcontrib>Burton, Thomas C</creatorcontrib><creatorcontrib>Csaky, Karl</creatorcontrib><creatorcontrib>Williams, George A</creatorcontrib><creatorcontrib>Ferris, Frederick L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of ophthalmology (1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chew, Emily Y</au><au>Benson, William E</au><au>Remaley, Nancy A</au><au>Lindley, Anna A</au><au>Burton, Thomas C</au><au>Csaky, Karl</au><au>Williams, George A</au><au>Ferris, Frederick L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Results After Lens Extraction in Patients With Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study Report Number 25</atitle><jtitle>Archives of ophthalmology (1960)</jtitle><addtitle>Arch Ophthalmol</addtitle><date>1999-12-01</date><risdate>1999</risdate><volume>117</volume><issue>12</issue><spage>1600</spage><epage>1606</epage><pages>1600-1606</pages><issn>0003-9950</issn><issn>2168-6165</issn><eissn>1538-3601</eissn><eissn>2168-6173</eissn><abstract>OBJECTIVE To assess the visual results after surgical lens removal in patients with diabetic retinopathy. DESIGN A multicenter randomized clinical trial designed to assess the effect of photocoagulation and aspirin in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy and/or macular edema. PARTICIPANTS Of the 3711 patients enrolled in the Early Treatment Diabetic Retinopathy Study, lens surgery was performed on 205 patients (270 eyes) during follow-up that ranged from 4 to 9 years. OUTCOME MEASUREMENTS Visual acuity, macular edema status, and degree of diabetic retinopathy. In addition, risk factors associated with lens extraction and with poor postoperative visual acuity (worse than 20/100) were assessed. RESULTS The risk of lens extraction increased with increasing age, female sex, and baseline proteinuria. Ocular variables associated with increased risk of lens surgery included poor baseline visual acuity and vitrectomy performed during the course of the study. At 1 year after lens surgery, visual acuity improvement of 2 or more lines from preoperative levels occurred in 64.3% of the operated-on eyes assigned to early photocoagulation and 59.3% of eyes assigned to deferral of photocoagulation. In eyes assigned to early photocoagulation, 46% of eyes achieved visual acuity better than 20/40; 73%, better than 20/100; and 8%, 5/200 or worse at 1 year after surgery. Visual acuity results for eyes assigned to deferral of laser photocoagulation at 1 year were not as favorable; 36% achieved visual acuity better than 20/40; 55%, better than 20/100; and 17%, 5/200 or worse at 1 year after surgery. Evaluation of 1-year postoperative visual acuities for all eyes with mild to moderate nonproliferative diabetic retinopathy at the annual visit before lens surgery showed that 53% were better than 20/40; 90%, better than 20/100; and 1%, 5/200 or worse. However, for eyes with severe nonproliferative or worse retinopathy at the annual visit before lens surgery, only 25% were better than 20/40; 42%, better than 20/100; and 22%, 5/200 or worse at 1 year after lens surgery. There was little change in visual acuity between 1 and 2 years postoperatively. Increased severity of retinopathy and poor visual acuity before surgery were associated with visual acuity of worse than 20/100 at 1 year after surgery. Lens surgery was associated with a borderline statistically significant increased risk of progression of diabetic retinopathy in the adjusted analyses (P=.03). No statistically significant long-term increased risk of macular edema was documented after lens surgery. CONCLUSIONS Visual acuity results after lens surgery in patients in the Early Treatment Diabetic Retinopathy Study were better than published results for similar patients. This may be because of more intensive photocoagulation for lesions of diabetic retinopathy in the Early Treatment Diabetic Retinopathy Study than in previously reported studies. Although patients with severe nonproliferative retinopathy or worse before lens surgery had poorer visual results, visual improvement was seen in 55% of these patients at 1-year follow-up. The main causes of poor visual results in eyes after lens surgery were complications of proliferative retinopathy and/or macular edema.Arch Ophthalmol. 1999;117:1600-1606--></abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>10604663</pmid><doi>10.1001/archopht.117.12.1600</doi><tpages>7</tpages></addata></record> |
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| subjects | Aspirin - therapeutic use Biological and medical sciences Cataract - complications Cataract - physiopathology Cataract - therapy Cataract Extraction Diabetic Retinopathy - complications Diabetic Retinopathy - physiopathology Diabetic Retinopathy - therapy Disease Progression Female Humans Laser Coagulation Macular Edema - complications Macular Edema - physiopathology Macular Edema - therapy Male Medical sciences Middle Aged Postoperative Complications Prognosis Prospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the eye and orbit Visual Acuity |
| title | Results After Lens Extraction in Patients With Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study Report Number 25 |
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