Investigating the safety and effectiveness of concurrent versus consecutive intra-vitreal Ranibizumab injection with phacoemulsification in eyes affected by diabetic macular edema affecting the central region and visually significant cataract

Aim
Investigating the safety and effectiveness of concurrent versus consecutive intra-vitreal ranibizumab injection with phacoemulsification in eyes affected by diabetic macular edema affecting the central region and visually significant cataract.
Methods
A retrospective review was conducted on 80 eyes (41 right) from 80 patients diagnosed with diabetic macular edema affecting the central region and accompanied by visually significant cataract. Data was collected from January 2021 to April 2023. The eyes involved in the study underwent a combined approach involving phacoemulsification and intravitreal injection of ranibizumab or intravitreal injection of ranibizumab followed 3 months later -if the macula was dry- by phacoemulsification (Delayed). Intravitreal ranibizumab injections were repeated (monthly) after phacoemulsification if the macula was not dry. Center-involved diabetic macular edema (Ci-DME) diagnosis and follow up was done by OCT. Follow up extended to 6 months after phacoemulsification.
Results
In the Combined approach, the average age of participants was 60.8 ± 4.5 years, compared to 62.2 ± 4.3 years in the Delayed group (p = 0.165). Preoperative and postoperative central foveal thickness were 534.8 ± 103 µ and 266.5 ± 14.9 µ in the Combined group (p < 0.05), and 526.5 ± 103 µ and 270.5 ± 18.3 µ in the Delayed group (p < 0.05) (p = 0.2807). Rebound center-involved diabetic macular edema (Ci-DME) occurred in 29% of the Combined group and 41% of the Delayed group (p = 0.385).
Conclusion
Combining phacoemulsification to intravitreal ranibizumab injection in eyes suffering Ci-DME and visually significant cataract is equally effective and safe as performing phacoemulsification after intravitreal ranibizumab injection and resolution of Ci-DME.
Keywords
Cataract; Cataract surgery; Phacoemulsification; Ranibizumab; and Anti-VEGF.