Diabetes Does Not Significantly Affect Outcomes of Epiretinal Membrane Surgery

A recent study conducted at Helsinki University Hospital, Finland, has found that diabetes does not significantly influence the anatomical or functional outcomes of epiretinal membrane (ERM) surgery. The research indicates that factors like glycemic control and insulin therapy have no notable impact on postoperative results, providing reassurance to ophthalmologists treating patients with diabetes.

Research Summary

The study analyzed data from 214 eyes of 214 patients who underwent ERM surgery between 2017 and 2021. Among the participants, 45 patients had a diagnosis of diabetes. The average age of patients was 71.2 ± 8.2 years, and outcomes were assessed one month after surgery.

Methods

All patients underwent comprehensive ophthalmological evaluations both before and after surgery, including:

       • Best-corrected visual acuity (BCVA) assessment.

       • Examination of the anterior segment and fundus with a slit lamp.

       • Retinal imaging using optical coherence tomography (OCT).

Key Findings

Comparable Surgical Outcomes

The comparison between diabetic and non-diabetic patients revealed no significant differences in:

     • Anatomical outcomes:

           - Foveal thickness changes:

                 1. Diabetic group: −47.8 ± 72.7 μm.

                 2. Non-diabetic group: −38.3 ± 103 μm (p = 0.566).

     • Central subfield macular thickness changes:

           - Diabetic group: −41.6 ± 61.8 μm.

           - Non-diabetic group: −41.7 ± 85.7 μm (p = 0.996).

     • Functional outcomes:

           - BCVA improvement:

                 1. Diabetic group: 0.06 ± 0.22 LogMAR units.

                 2. Non-diabetic group: 0.12 ± 0.30 LogMAR units (p = 0.214).

Impact of Glycemic Control and Insulin Therapy

       • HbA1c levels: Showed no significant correlation with changes in foveal thickness (r = 0.218, p = 0.264), central macular thickness (r = 0.365, p = 0.056), or BCVA improvement (r = −0.177, p = 0.386).

       • Insulin therapy: Had no significant impact on surgical outcomes (p > 0.05 for all comparisons).

Multivariate Analysis

Adjusting for factors such as age, sex, preoperative macular cysts, and use of topical NSAIDs confirmed that diabetes did not negatively influence surgical outcomes.

Implications for Clinical Practice

The researchers concluded:

“The degree of improvement was comparable between patients with and without diabetes. Poor glycemic control or need for insulin treatment were not associated with worse surgical outcomes and should not result in postponing the surgery.”

This provides reassurance to ophthalmologists that diabetic status alone should not deter or delay ERM surgery.

Study Limitations

The authors noted several limitations, including:

       • Short follow-up period: The one-month duration precluded analysis of long-term outcomes.

       • Prognostic biomarkers not assessed: Future research will examine OCT biomarkers such as ellipsoid zone integrity and photoreceptor outer segment length.

       • Limited imaging modalities: Only SD-OCT was used, and advanced imaging or deep learning tools were not included.

       • Lack of direct diabetic retinopathy assessment: Diagnoses relied on medical records and preoperative evaluations rather than fundus photography.

Conclusion

The study confirms that diabetes, glycemic control, and insulin therapy do not adversely affect anatomical or functional outcomes after ERM surgery. These findings reassure ophthalmologists that diabetic patients can achieve comparable surgical success to non-diabetic patients. Future studies with longer follow-ups and advanced imaging methods are needed to further evaluate long-term outcomes and prognostic factors.

Reference:

Hecht, I., Karesvuo, M., Kanclerz, P. et al. The effect of diabetes on short-term outcomes following epiretinal membrane surgery. Int Ophthalmol 44, 446 (2024). https://doi.org/10.1007/s10792-024-03373-6