Study Tests Cataract Surgery Methods for Patients With Diabetic Retinopathy

two doctor doing cataract surgery in operating room
Researchers report on structural changes following traditional phacoemulsification and femtosecond laser-assisted cataract surgery for these patients.

Femtosecond laser-assisted cataract (FLACS) surgery is a safe and effective procedure for patients with mild diabetic retinopathy and results in good vision and faster recovery on a quicker time frame compared with traditional phacoemulsification (PE) surgery, according to research published in Ophthalmology and Therapy. 

Researchers conducted a prospective study of people with diabetes to compare short-term changes in central macular thickness and subfoveal choroidal thickness following cataract surgery with intraocular lens implantation using either FLACS or PE.

Participants (n=91) were divided into 2 surgical groups: the PE group included 47 eyes (28 women; average age, 69.32 years ± 6.24 years) and the FLACS group, which included 44 eyes (26 men; average age, 70.77 years ± 7.24 years).

No significant differences were noted between groups in terms of age, diabetic history, HbA1c, anterior chamber depth, lens grade, axial length, intraocular pressure, best-corrected visual acuity (BCVA), central macular thickness, or subfoveal choroidal thickness. EPT was 6.60 seconds in the PE group and approximately 2.34 s in the FLACS group. 

Investigators found a significant difference in BCVA between the groups at postoperative week 1 and month 1. Within both groups, the difference between baseline and postoperative BCVA was statistically significant. Additionally, 3 patients from the FLACS groups and 5 patients from the PE group were lost to follow up.

No significant differences in terms of central macular thickness were found between the groups at baseline or any postoperative follow-up points; however, within the PE group, the difference in baseline and postoperative values were statistically significant at all time points. This was true also in the FLACS group, except at month 12 (P =.859). 

Subfoveal choroidal thickness difference was significant between groups only at month 12 (P =.033). The PE group demonstrated a significant difference between baseline and postoperative subfoveal choroidal thickness values, and postoperative subfoveal choroidal thickness was significantly different in the FLACS group at weeks 1 and months 1 and 3. 

Researchers conducted a multiple linear regression analysis of each group. In the PE group, baseline CMT was predictive of postoperative central macular thickness at week 1, month 1, month 3, and month 2; effective phaco time predicted subfoveal choroidal thickness at month 3. In the FLACS group, baseline central macular thickness values were predictive only of values at week 1, month 1, and month 3, with ametropia predictive of subfoveal choroidal thickness at month 12. 

Study limitations include the small sample size, the use of patient preference, rather than randomization, to dictate the surgical groups and the collection of choroidal thickness via manual measurements. Patients with moderate to severe nonproliferative and proliferative diabetic retinopathy were not included in the study, limiting generalizability. 

“Compared with traditional PE surgery, FLACS effectively reduced [effective phaco time], achieving good vision earlier and earlier recovery of retinal and choroidal thickness,” the research says. “Further studies are needed to confirm these findings.” 


Ma L, Rong A, Jiang Y, Deng S. Effects of femtosecond laser-assisted cataract surgery on macular and choroidal thickness in diabetic patients.  Ophthalmol Ther. Published online January 19, 2021. doi:10.1007/s40123-020-00326-x