The level of glycated hemoglobin as the rationale for the most appropriate anti-inflammatory therapy after cataract surgery in diabetic patients

Abstract

Purpose. To study the effect of various anti-inflammatory regimens containing steroids on changes in blood glucose levels in patients with type 2 diabetes mellitus (DM T2) after cataract surgery.Material and methods. We observed 83 patients (83 eyes) after phacoemulsification: 68 patients of them with non-insulin dependent DM T2 (NID) and 15 patients without DM. At the end of the surgery sub-tenon’s injections of prolonged steroid (betamethasone) were performed in patients with NIDDM T2 of the main group (35 eyes). For patients with NIDDM T2 of the comparative group (33 eyes) steroid eye drops (dexamethasone) instillations were assigned within 1 month postoperatively. Steroid therapy was not carried out in patients without DM.Results. The level of glycated hemoglobin (HbA1c) and glycemic profile was determined during 1 day after surgery in all patients. The blood glucose level in patients with NIDDM of the main group increased by almost 40%, in the comparative group – by 25%, in non-diabetic patients – by 24% of the initial one (р<0.0005). Correlation analysis of HbA1c level with the degree of postoperative hyperglycemia in patients with NIDDM revealed a significant strong direct positive relationship in both groups (r=0.84; р<0.05).Conclusions. The increase of blood glucose level after phacoemulsification indicates a significant effect of stress on the dynamics of postoperative glycemia both in NIDDM patients and nondiabetic patients. Meanwhile, the availability of significant strong positive correlation of hyperglycemia degree with the HbA1c level, determines the appropriateness of prolonged steroids injections in patients with NIDDM exclusively under the control of the endocrinologist.

Keywords

• hyperglycemia
• glycated hemoglobin
• diabetes mellitus
• corticosteroids
• betamethasone
• dexamethasone
• cataract surgery.